Page 4 - Lifeguard Application

LIST THREE CHARACTER REFERENCES. THESE PERSONS MUST NOT BE RELATED TO
YOU, NOR CAN THEY BE PERSONS LISTED ELSEWHERE ON THIS FORM.

NAME ADDRESS PHONE NO. OCCUPATION

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

I HEREBY AFFIRM THAT THIS APPLICATION CONTAINS NO WILLFUL MISREPRESENTA-
TIONS OR FALSIFICATIONS AND THAT THIS INFORMATION GIVEN BY ME IS TRUE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AM AWARE THAT SHOULD
INVESTIGATION AT ANY TIME DISCLOSE ANY MISREPRESENTATIONS OR FALSIFICA-
TION, MY APPLICATION WILL BE DISAPPROVED, MY NAME REMOVED FROM THE
ELIGIBLE LIST, AND THAT I WILL NOT BE CERTIFIED FOR EMPLOYMENT IN ANY
POSTION WITH THE HOLLYWOOD SHORES CIVIC ASSOCIATION.

YOU MAY CONTACT MY PRESENT EMPLOYER: YES________ NO_________

________________________________ ___________________________________________________
(Date) (Signature of Applicant)

PLEASE FORWARD THIS COMPLETED APPLICATION TO:

PRESIDENT
HOLLYWOOD SHORES CIVIC ASSOCIATION
P.O. BOX 397
HOLLYWOOD, MARYLAND 20636