Personal Information
Full Name
Date of Birth
Current Address
Permanent Address
Phone Number
E-Mail Address
Social Security Number
Height
Weight
Sex
Education
High School
Years Attended	1 2 3 4 5 6
Did You Graduate	Yes No
College
Years Attended	1 2 3 4 5 6
Major
Did You Graduate	Yes No
Additional Education
Work Experience
1. Employer
Position
Dates Employed	From To
2. Employer
Position
Dates Employed	From To
3. Employer
Position
Dates Employed	From To
Personal References
1. Name
Address
Business
Years Acquainted
2. Name
Address
Business
Years Acquainted
3. Name
Address
Business
Years Acquainted
Applicant Statement	I am in good mental and physical health without any limitations that would preclude me from performing a lifeguard test or any work for which I am being considered. Agree Disagree