Westside Splash Club

Employment application












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Date__________ Name_________________________________ SS#_________________

Address____________________________ City/State____________________ Zip______

Home Phone____________________ E-Mail Address______________________________

Other Phone______________________ Date of Birth_____________________________

Position Applying for________________ Full time__ Part time__ or Hours desired per wk____

Previous Employee: Yes___ No___ If yes, when___________________ Salary___________

Parents’ names _____________________________ Referred by _____________________

Name of School_____________________________________ Last grade attended_______

Attending Summer School:

Yes___ No___ If yes, Days and times___________________________________________

Summer/Fall sports:

Yes___ No___ If yes, Days and times___________________________________________

Leaving for college: Yes___ No___ If yes, Approximate date_________________


Type of certification______________________________________ Date_______________

Taught swimming lessons:

Yes___ No___ If yes, Where and when__________________________________________

Work/Personal References:

Name_____________________________________________ Phone_________________

Name_____________________________________________ Phone_________________

Name_____________________________________________ Phone_________________

Allergies______________________________________________________________________

 

Physician___________________________________________ Phone________________
Mail to: 3645 East Main Street

         # 104

         Richmond, IN 47374