Lifeguard Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Will you be 15 years old or older on May 1st of this year?
*
Yes
No
Number of seasons worked as a lifeguard:
With Pool Specialists:
Lifeguard Certification Expiration:
00/00/0000
Type of Certification
American Red Cross
YMCA
List any other employment, experiences, or qualifications:
References
Reference 1 Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Reference 2 Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Please verify that you are human
*
Submit
Should be Empty: