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Lifeguard Application
 
 
Applicant Name: *
 
Date: *
Position(s) applied for or type of work desired:
Address:
Telephone Number:
 
E-mail Address:
Type of employment desired:
Please indicate your availability for the following:


Date you will be available to start work:
Salary Expectations:
Vacation or Time-Off Request Dates:
Have you been previously employed by Syndeo Staffing?
Have you ever worked for the City of Wichita?
If yes, please list dates of employment:
Are any relatives or anyone who lives in your residence employed by the City of Wichita?
If yes, please list department, relationship and name:
Can you submit proof of legal employment authorization and identity?
If you are under 18, can you furnish a work permit if it is required?
Have you been convicted of a criminal offense?
If yes, where did the offense(s) occur? (A conviction will not automatically bar employment). Please provide County and State.
Were you ever discharged or forced to resign from any position?
Drivers License Number (if driving is an essential job duty):
How were you referred to us?
Certifications: (Please provide the kind of certifications you have and their expiration date)
LGT (Lifeguard Training) Expiration Date:
LGI (Lifeguard Instructor) Expiration Date:
CPR (CPR for the Professional Rescuer) Expiration Date:
Employment History:
Please provide all employment information for your past four employers starting with the most recent.
May we contact your current employer?
In the spaces below, please provid the name of the Employer, Address and Phone Number, Position Held, Immediate Supervisor, Dates of Employment, Salary, Job Summary and Reason for Leaving.
Employer 1:
Employer 2:
Employer 3:
Employer 4:
Other Skills & Qualifications:
Summarize any job-related training, skills, licenses, certificates, and/or other qualifications.
Educational History:
List school name and location, years completed, course of study, and any degrees earned:
High School:
College:
Technical Training:
Other:
References:
List 3 references names, telephone numbers and years known (do not include relatives or employers):
I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references.
I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.
I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.
Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.
I understand that it is the policy of this organization not to refuse to hire or otherwise discriminate against a qualified individual with a disability because of that person’s need for a reasonable accommodation as required by the ADA.
I understand that if I am employed, I will be required to provide satisfactory proof of identity and legal work authorization within three days of being hired. Failure to submit such proof within the required time shall result in immediate terminatio
I further understand that to be hired for this position, I will be subject to drug screening, a physical exam, a criminal record check, and, if applicable, a driver’s license check. I also agree to conform to the rules of Syndeo Staffing.
I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.
 
Applicant Signature: *
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