Pool Monitor Application Name * First Name Last Name Email * Age Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Are you lifeguard certified? * Yes No CPR Certified? * Yes No Prior Work Experience Employer/Volunteer #1 Name Employer/Volunteer #1 Phone (###) ### #### May we contact them? Yes No Date service started MM DD YYYY Date service ended MM DD YYYY Description Briefly describe how you think your prior work experience would benefit you in the position you are seeking Employer/Volunteer #2 Name Employer/Volunteer #2 Phone (###) ### #### May we contact them? Yes No Date service started MM DD YYYY Date service ended MM DD YYYY Description Briefly describe how you think your prior work experience would benefit you in the position you are seeking Volunteer/Extra Curricular Experience Reference Name Reference Phone (###) ### #### Thank you!
