Aquatic Safety Instruction

Your Full Name:
Your E-Mail:
Address:
City, State & Zip:
Home Phone:
Cell Phone:
Social Security No:
Birth Date:
Date Available:
Position Applied For:
Desired Salary:
Are You A Citizen of the United States? YesNo If no, are you authorized to work in the US? YesNo
Have you ever worked for this company? YesNo
If so when?
Have you ever been convicted of a felony? YesNo
If yes please explain:
Any pending investigations including Department of Family Services: YesNo
If yes please explain:
Education:
High School & Dates Attended:
School Address:
Did you graduate:	YesNo
College & Dates Attended:
College Address:
Did you graduate:	YesNo
Other Education & Dates Attended:
Address:
Did you graduate:	YesNo
Please list computer skills and other office strengths:
Please list your current certifications:
References: Please list three professional references:
Contact Name:
Relationship:
Company:
Phone & Area Code:
Address:
City, State & Zip :

Contact Name:
Relationship:
Company:
Phone & Area Code:
Address:
City, State & Zip :

Contact Name:
Relationship:
Company:
Phone & Area Code:
Address:
City, State & Zip :

Previous Employment:
Company:
Phone & Area Code:
Address:
City, State & Zip:
Job Title:
Dates Employed:
Responsibilities:
Starting & Ending Salary:
Supervisor:
May we contact your supervisor? Yes No

Company:
Phone & Area Code:
Address:
City, State & Zip:
Job Title:
Dates Employed:
Responsibilities:
Starting & Ending Salary:
Supervisor:
May we contact your supervisor? Yes No

Company:
Phone & Area Code:
Address:
City, State & Zip:
Job Title:
Dates Employed:
Responsibilities:
Starting & Ending Salary:
Supervisor:
May we contact your supervisor? Yes No

Military Service:
Branch:
Dates Served:
Rank at Discharge:
Type of Discharge:
If other than honorable, explain:
Our polices: ASI requires full background checks and fingerprints all employees and potential employees.
Please list three things you want us to know about you. Areas of your strengths and weaknesses:

Must be acknowledged to submit:
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I CertifyI Decline