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
Do you have a current Lifeguard certification?

YesNo
Do you plan to have current certification before June?

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: