Page 1 - Lifeguard Application
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HOLLYWOOD SHORES CIVIC ASSOCIATION
                                                       P.O. BOX 397
                                           HOLLYWOOD, MARYLAND  20636

                                               LIFEGUARD APPLICATION
                                (Must Provide Social Security Number Required when Hired)

               NAME ___________________________________________________     DATE_____________
                                         (Last)                                         (First)                                         (Middle)

               PRESENT ADDRESS__________________________________________________________________

                                                   __________________________________________________________________

               TELEPHONE NO.___________________________________


               EMAIL ADDRESS ____________________________________________________________________


               IN CASE OF EMERGENCY CONTACT __________________________________________________
                                                                                                                                                                         (Name)

               ADDRESS ___________________________________________________________________________

               TELEPHONE NO______________________________________________________________________

               DO YOU HAVE YOUR OWN TRANSPORTATION?   YES____________    NO____________

               ARE YOU AGE 16 OR OLDER?    YES____________   NO____________

               DO YOU HAVE ANY IMPAIRMENT, PHYSICAL OR MENTAL, WHICH WOULD INTERFERE
               WITH YOUR ABILITY AS A LIFEGUARD?  __________ IF YES, PLEASE EXPLAIN
               _____________________________________________________________________________________

               _____________________________________________________________________________________

               _____________________________________________________________________________________

               LIST ALL LIFE-SAVING, FIRST AID, CPR, POOL MANAGER, AND OTHER CERTIFICATES
               THAT YOU HOLD (Use back of application if necessary).

               1.____________________________________________________________   DATE________________

               2.____________________________________________________________   DATE________________

               3.____________________________________________________________   DATE________________

               4.____________________________________________________________   DATE________________

               STATE WHY YOU ARE THE BEST CANDIDATE FOR THIS POSITION_______________________

               _____________________________________________________________________________________

               _____________________________________________________________________________________
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