Lifeguard Application 2026

Lifeguard Application 2026
Full Name*

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone Number
YesNo
YesNo
Certification Expiration Date

MonthDayYear
By what date do you plan to be certified?
Previous Work Experience
Company Name #1
Supervisor

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Company Name #2
Supervisor

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Company Name #3
Supervisor

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
References
Reference #1

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Reference #2

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Should be Empty: