Hazen Parks and Recreation Department

Swimming Pool Employment Application

Have you worked at our Swimming Pool before Yes No

If so, position held and specific assignments____________________________________

________________________________________________________________________

Full Name: ______________________________________________________________

Present Address: __________________________________________________________

Mailing Address: _________________________________________________________

Telephone where you can be reached: _________________________________________

Current Drivers License Yes No Class: ______ State: ______

General Information:

Position Applying for: _____________________________________________________

Date available to start: ________________ Hours Available: _____________________

Are there any days you cannot work or long term absences that you are aware of: _____

_______________________________________________________________________

American Red Cross Certifications and Expirations:

Lifeguard Training: _________________ Water Safety Instructor: ________________

Standard First Aid: __________________ CPR: _______________________________

Other Certifications: _______________________________________________________

Education Information:

High School: ____________________________________ Year Graduated: __________

College: ______________________________________ Year Graduated: __________

Work History: Start with most recent employer first

Employer: ______________________________________ Dates: __________________

Title: ___________________________________________ Salary: _________________

Reason for Leaving: _________________________ Duties: _______________________

Employer: ______________________________________ Dates: __________________

Title: ___________________________________________ Salary: _________________

Reason for Leaving: _________________________ Duties: _______________________

Employer: ______________________________________ Dates: __________________

Title: ___________________________________________ Salary: _________________

Reason for Leaving: _________________________ Duties: _______________________

May we contact the most recent employer? Yes No

References please list 3 people not related to you whom you have known for more than 1 year.

Name

Address

Occupation

Telephone

In case of emergency, notify (include name, address, phone number, relationship):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

The Hazen Parks and Recreation Department may request a background check on all individuals who are offered employment by the department. The Fair Credit Reporting Act (1971) requires that we inform you that a background investigation may be conducted as part of our employment screening and selection process. This may include an inquiry to obtain information regarding your character, criminal history, general reputation, personal characteristics, credit report and mode of living. The main objective of this investigation is to verify information you provide on your application or during the interview process. If a report is made, you have the right to request details of the report from the consumer reporting agency.

I certify that the above information in this application is true and correct to the best of my knowledge.

Signature: _____________________________________________ Date: _____________

Please return application to: The Hazen Parks and Recreation Office

146 East Main Street

P.O. Box 717

Hazen, ND 58545

Phone: (701) 748-6948

Do not write below this line:

Interviewed by: _______________________ Date: ______________

Hired: Yes No Position: ______________________________

Comments: ______________________________________________________________
________________________________________________________________________
________________________________________________________________________