Lighthouse Pool Management, Inc. | Application
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Personal Information
Last Name
First Name
Middle Initial
Social Security Number
Date of Birth
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Street Address
City
State
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Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Home Phone
Including area code
Cell Phone
Including area code
Email
Position & Availability
Positions Desired
Pool Desired
Will you be available?
Full-time
Part-time
Substitute
Are you involved in any activities that may conflict with a full-time schedule?
Yes
No
If yes, please explain.
Will you be available to work full-time beginning Memorial Day weekend?
Yes
No
Will you be available to work through Labor Day?
Yes
No
If no, when will be your last day? (If known)
Do you have any vacations planned?
Yes
No
If yes, please give dates of unavailability (If known)
Education
Name of High School
Location
Graduation Date
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Name of College/University
Location
Graduation Date
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Certifications
Are you a Red Cross (or other A.L.A approved certified lifeguard)?
Yes
No
If yes, please list the date your certification expires.
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CPR Certification
Certified
Need Certified
Certification Exp Date
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First Aid Certification
Certified
Need Certification
Certification Exp Date
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Prince George Co. Pool Operators
Certified
Need Certification
Certification Exp Date
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Montgomery Co. Pool Operators
Certified
Need Certification
Certification Exp Date
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Ann Arundel Co. Pool Operators
Certified
Needs Certification
Certification Exp Date
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Past Employment / Pool Expierience
Company
Position
Begin Date
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End Date
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Pay Rate
Company
Position
Begin Date
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End Date
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Pay Rate
Emergency Contact
In Case of an emergency, please notify
Telephone
Including area code
Can you perform the essential functions of this job with or without reasonable accommodations?
Yes
No
What, if any, accommodations are required?
Are you legally authorized to work in the United States ?
Yes
No
Have you ever been convicted of a felony?
Yes
No
If yes, please explain:
Security Code:
*