Application for Summer Employment

Woodbury Parks & Recreation

= = = &nb= sp; = P.O. Box 21, Highland Mills, NY 10930

&= nbsp; &nbs= p; Phone: 845-928-9588, Extension 6

= = Fax: 845-928-8240=

&nb= sp; = &nb= sp; Email: parknrec@optonline.net

&= nbsp; &nbs= p; Website: www.woodburyparknrec.com

<= span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt'>

= AP= PLICATION FOR 2008 SUMMER EMPLOYMENT

= &nb= sp; = Check position applying for: ____________Lifeguard

&nb= sp; = &nb= sp; = &nb= sp; = ____________Gatekeeper

Date:______________ &= nbsp; &nbs= p; &= nbsp; ____________Security=

= &nb= sp; = &nb= sp; = &nb= sp; ____________Arts & Crafts<= /o:p>

= &nb= sp; = &nb= sp; = &nb= sp; ____________Other (Specify)

(PLEASE PRINT)&nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

NAME: = _______________________________________________________________________

&= nbsp; &nbs= p; Last &= nbsp; &nbs= p; &= nbsp; First &= nbsp; &nbs= p; &= nbsp; Middle Initial

HOME ADDRESS: _____________________________________________________________

   &= nbsp;           &nbs= p;             ______________________________________________________________<= /o:p>

AGE: _____________ DATE OF BIRTH: _________________= PHONE NO.: _______________

SOCIAL SECURITY NUMBER: ___________________________= ___

EDUCATION:

CIRCLE NO. OF HIGH SCHOOL YEARS COMPLETED:   1 2 3= 4 (AS OF JUNE OF THE        =

   =             &nb= sp;            =             &nb= sp;            =             &nb= sp;            =             &nb= sp;           UPCOMING YEAR)

   &= nbsp;           &nbs= p;        SCHOOL        &= nbsp;           &nbs= p;            FROM        &= nbsp; TO            DEGREE        &= nbsp;      MAJOR

   =             &nb= sp;            =             &nb= sp;            =                  MO/YR      MO/YR

________________________________    ________     ________       ________       ____= ___

HIGH SCHOOL

________________________________      ________     ________      ________       ____= ___

COLLEGE

________________________________    ________     ________       ________    &nb= sp; _______

GRADUATE OR PROF. SCHOOL

REFERENCES:

LIST THREE REFERENCES WITH THEIR ADDRESSES AND TELEP= HONE NUMBERS (MUST BE SOMEONE OTHER THAN A RELATIVE OR FRIEND. TEACHERS, CLERGYMEN, PREVIOUS EMPL= OYERS ACCEPTABLE)

        =     NAME AND TITLE   &nbs= p;            &= nbsp;            = ADDRESS     = ;            &n= bsp;            =    TEL. NO.

1. _________________________     _____________________________ = _______________

   _________________________     _____________________________     _______________<= o:p>

2. ________________________ ____________________________        ________________<= /b>

   ________________________      _____________________________    ________________<= /o:p>

3. _______________________       _____________________________    ________________<= /o:p>

   ________________________      _____________________________    ________________<= /o:p>

=

=

EMPLOYMENT:

   &= nbsp;        ARE YOU CURRENTLY EMPLOYED?   &= nbsp; _______YES        =           _______NO

   =             &nb= sp;            =             &nb= sp;            =             &nb= sp;

   =             &nb= sp;            =             &nb= sp;            =                      = ______FULL TIME        _______PART TIME

LIST YOUR LAST THREE EMPLOYERS STARTING WITH YOUR CURRENT/MOST RECENT POSITION:<= o:p>

    ADDRESS                   =          FROM<= span style=3D'mso-tab-count:3'>        &= nbsp;      TO

   =             &nb= sp;            =             &nb= sp;            =             &nb= sp;              =              =                MO/YR=         =    MO/YR

1. ______________________        ___________________________     _______         _______

=

2. ______________________       ____________________________    _______         ________

3. ______________________      ____________________________     _______         ________

=

CHECK CURRENT CERTIFICATIONS HELD:

AMER. RED CROSS STANDARD FIRST AID &n= bsp;         _____      DATE ISSUED ______   DATE EXPIRES ______

AMER. RED CROSS LIFEGUARDING COURSE        _____=       DATE ISSUED ______   DATE EXPIRES ____= __

CPR (BLS)     =             &nb= sp;            =             &nb= sp;                         _____       DATE = ISSUED ______   DATE EXPIRES ____= __

WATER SAFETY INSTRUCTION    &= nbsp;                &nb= sp;        _____       DATE = ISSUED ______   DATE EXPIRES ____= __

HAVE YOU A DRIVERS LICENSE? ____________________

HAVE YOU WORKING PAPERS? _____________________

HAVE YOU EVER BEEN CONVICTED OF A CRIME OTHER THAN A TRAFFIC CONVICTION? ______________

(IF YES, SPECIFY) ___________________________________________________________________________= __

DO YOU OBJECT TO AN INVESTIGATION OF YOUR BACKGROUND? __________________________________

HEALTH:

HAVE YOU ANY PHYSICAL DISABILITIES, ALLERGIES, ETC? ____________________________

______________________________________________________= _______________________

______________________________________________________= _______________________

PERSONAL ACHIEVEMENTS OR AWARDS_____________________________________________________= ______

____________________________________________________________________= ____________________________

EARLIEST DATE AVAILABLE TO WORK? MAY __________________OR JUNE ______________________= _____

CAN YOU WORK THROUGH LABOR DAY? _________________ IF NO, UN= TIL WHEN? ______________________

TELL WHY YOU WANT THIS JOB AND WHY YOU CONSIDER YOU= RSELF QUALIFIED:

___________________________________________________= __________________________

___________________________________________________= __________________________

___________________________________________________= __________________________

___________________________________________________= __________________________

= AP= PLICATION FOR 2008 SUMMER EMPLOYMENT

= &nb= sp; = Check position applying for: ____________Lifeguard

AMER. RED CROSS LIFEGUARDING COURSE _= DATE ISSUED DATE EXPIRES =

CPR (BLS) = &nb= sp; = &nb= sp; _ DATE = ISSUED DATE EXPIRES =

HAVE YOU ANY PHYSICAL DISABILITIES, ALLERGIES, ETC? ____________________________