Swim Coach Application

Swim Coach Application
Submission deadline is April 30
Name*
First Last
Birth Date*
MM slash DD slash YYYY
Phone*
Gender*
- male
- female
Address*
Street Address City State ZIP Code
Email*
JVRA MEMBER*
*membership is not a requirement for employment*
- yes
- no
Position
Position(s) applying for:*
- Swim Coach
Certifications
Certification/License Uploads
CPR/AED
Upload a PDF of CPR/AED Certification
Max. file size: 10 MB.
Certification Date
Enter either the expiration date of your current CPR/AED certification or the completion date of a future certification.
MM slash DD slash YYYY
Lifeguard/First Aid
Upload a PDF of your Lifeguard/First Aid certification
Max. file size: 10 MB.
License Date
Enter either the expiration date of your current Lifeguard cert, or the completion date of a future license.
MM slash DD slash YYYY
Employment History
Employment History & References
Personal References (asst manager position only): name and phone number
Current or Most Recent Employer
First Last
Employer Phone Number
Please List References*
Reference Name Reference Phone Reference Email
Signature*
By signing this application I understand that, as a condition of my employment, I will adhere to the requirements stated in the JVRA Operations Manual and the Rules and Regulations of the Association. I understand that any violation of these policies and rules, may result in the termination of employment.
CAPTCHA
Order Token

Position

Reference Name	Reference Phone	Reference Email