Harrington Grove Swim & Tennis Club, Raleigh NC 27613 2023

Applicant Information

Full Name:	Date:
Last	First	M.I.

Address:
Street Address	Apartment/Unit #

City	State	ZIP Code

Phone: cell	Email

Position Applied for:

Experience at this position: YES NO # of Years________ Where _______________________________________

Are you a citizen of the United States?	YES	NO	If no, are you authorized to work in the U.S.?	YES	NO

Are you a member of Harrington Grove?	YES	NO

Are you on HG Swim Team or Another Team Yes No Where _____________________________________

Have you ever been convicted of a felony?	YES	NO

If yes, explain:

Education

High School:	Address:

From:	To:	Did you graduate?	YES	NO	Diploma:

College:	Address:

From:	To:	Did you graduate?	YES	NO	Degree:

Other:	Address:

References / Jobs / Experience

Are you Professional Rescuer Certified (life guard) Yes, No Date of certification:

If NOT, when are you taking the class?

Hours per week available to work:

Please write why you are applying for this job?

Please list two professional references. Jobs/ Teachers

Full Name:	Relationship:
Company:	Phone:
Address:
Full Name:	Relationship:
Company:	Phone:
Address:

Previous Employment

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO
List any other Jobs/ or notes if applicable:

Summer Camps or Sports Dates:

Family Vacations Dates if Known:

Other Summer Obligations:

Hours per week available to work:

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.

Signature:	Date:

Please submit application to:

Monica Shea-Henderson

5209 Country Trail

Raleigh, NC 27613

OR EMAIL TO: shamrockmd@hotmail.com