Position you are applying for (please check one):

- Pool Attendant
- Lifeguard
- Pool Manager
- Swim Lesson Instructor
- Other

Personal Information
Your Full Name (As it appears on your Social Security Card): 
Prefer to be called by: 
Address (summer): 
City: State: Zip Code: 
Phone: 
Email Address: (Must be filled out to send form) 

Availability

Position Applying For: 
What major intersection are you close to: 
Do you have transportation to work? Yes / No 
Dates available to work?
Start 
Finish 

School Experience
High School: 
Grade Point Average: 
College: 
Grade Point Average: 
Major: 
Year (freshman, sophomore, etc): 
 

Clubs, activities, sports, etc:
Awards, Honors, and Leadership Positions held:

WORK EXPERIENCE (List most recent job first. Please include any lifeguard experience you have)

First
Company Name:
Your Position:
Dates Worked:
Your Supervisor/Phone #: 
 

Your major job duties:

Second
Company Name:
Your Position:

Dates Worked:
Your Supervisor/Phone #: 
 

Your major job duties:

Third
Company Name:
Your Position: 

Dates Worked: 
Your Supervisor/Phone #: 
 

Your major job duties:

REFERENCES (List people other than family and peers. Use at least one teacher or coach)
Name: Profession: 
Phone #: 
Years Known: 
Name: Profession: 
Phone #: 
Years Known: 
Name: Profession: 
Phone #: 
Years Known: 

MISCELLANEOUS INFORMATION
How did you hear about Carolina Pool Management-Northside? 
Emergency Notification: Name 
Phone #