PDF School Area of Study Years Completed Degree Obtained?
[Pages:2]Employment Application
DuPage Swimming Center, Inc. 520 N. Oakhurst Dr. Aurora, IL 60502
630-692-1500 ? 630-692-1528 fax
Name:__________________________________________ Social Security Number:______________________
Are you over the age of 18 years? Yes No
If under 18, please list birth date: _____________________________________ (All applicants must be at least15 years of age)
Address:_______________________________________________________________________
Street
City
State
Zip
Phone Number:________________________________ e-mail Address:________________________________
In case of emergency notify:_________________________________________________________
Name
Relationship
Phone
Applying for: __________ Front Desk __________ Swim Instructor __________ Lifeguard
Education:
School
Area of Study
Years Completed Degree Obtained?
Past Work Experience:
1. Organization Name: Address: Name and Title of Supervisor: Salary/Hourly Wage:
2. Organization Name: Address: Name and Title of Supervisor: Salary/Hourly Wage:
Current Certifications: Name
Title:
Reason for leaving: Title:
Reason for leaving:
Start Date:
Phone:
Can we Contact? Yes No
End Date:
Start Date:
Phone:
Can we Contact? Yes No
End Date:
Agency
Please complete reverse side
Expiration Date:
Availability:
Day of Week: Monday
School Year (Sept ? May):
Available From:
Available To:
Not Available to Work:
Day of Week: Monday
Summer (June ? August):
Available From:
Available To:
Not Available to Work:
Tuesday
Tuesday
Wednesday
Wednesday
Thursday
Thursday
Friday
Friday
Saturday
Saturday
Sunday
Sunday
Desired Number of Hours Per Week:
Desired Number of Hours Per Week:
Extra Curricular activities that impact your availability:
Sport/Activity
Month(s) of Commitment
Can you work at this time?
If yes, what days/times?
Related Questions:
Can you commit to a full year of employment?
If you were referred by a current employee, please give employee's name:
Have you been convicted of a crime which has not been expunged, annulled, or sealed by a court? If yes, explain:
Are you legally eligible to work in the United States?
Are you subject to a non-compete agreement or other agreement which would restrict your employment with us? If yes, please describe:
Acknowledgement: I certify that the information given on this application, accompanying information given, or to be given in any personal interview is a true and accurate representation of fact, and I understand that any misrepresentation or omission of such fact is grounds for immediate dismissal, no matter when discovered.
I further understand that any employment is conditional upon receipt of satisfactory references from former employers. I hereby authorize the DuPage Swimming Center and its agents to request and receive references from all past and present employers, schools or others who may provide any reference information from any and all liability resulting from such investigation.
I have carefully read the above Information Acknowledgement and I understand and agree to all of the statements.
_________________________________________________ Applicant Signature
_________________________ Date
................
................
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