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Pre-Registration
 Job Application

Please fill-in as much information as possible. We will confirm your information by telephone.

Be advised that all required fields (*) must be filled-in, otherwise no information will be sent to Take Me To The Water.

General:
*I'm applying for:  
Personal Info:
*First Name: 
*Last Name: 
Middle Initial:
*Address: 
*City: 
*State: 
*Zip Code: 
*Tel: 
Tel2: 
*Email:
Do you have any of these Swimming Certifications?:
 WSI:           Exp. Date: 
 LGT:            Exp. Date: 
 CPR:            Exp. Date: 
 FirstAid:      Exp. Date: 
Others (Please describe): 
Days/Hours available for teaching swimming: 
References:
(1)Name of Location:  Tel: 
Contact:  Period: 
Job Description & Teaching Experience
(2)Name of Location:  Tel: 
Contact:  Period: 
Job Description & Teaching Experience
Medical:
Doctor's Name:  Tel:  Date/Last exam: 
Any Mediacl Condition?
Miscellaneous:
Are you currently:   Going to school     Employed     Unemployed
Have you worked for us before:  
Best time to call you back:  

Any other comments?

* Required Fields