Employment Application Please submit this simple contact form and we will contact you with our full application process. ABOUT YOU Your Name Address Telephone Best time to call Emergency Contact Name Your Email (required) GENERAL Position Date you can start Times Available: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Specify any hours or days you cannot or will not work Upon request can you provide proof that you are authorized to work in the United States? YesNo Are you over 18 years of age? YesNo Have you ever worked for us? YesNo If so, when and where Have you ever applied to work with us before? YesNo If so, when and where How were you referred to us? List any friends, acquaintances, and relatives working at Little Whale and their relationship to you Education High School or GED Graduated? YesNo Post-Secondary School Post-Secondary School Graduated? YesNo Additional Education Type of degree/diploma/certificate Major/Subjects studied Other Employment History (List below the last three employers starting with the most recent first. For all dates, include Month and Year.) Employer Employer Address Employer Phone Date Started Date Ended Position If currently employed, may we contact your present employer? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Employer Employer Address Employer Phone Date Started Date Ended Position If currently employed, may we contact your present employer? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Employer Employer Address Employer Phone Date Started Date Ended Position If currently employed, may we contact your present employer? YesNo Brief description of your responsibilities Reason for leaving What did you like most about this job Add Another Employer Other Relevant Background Specify any special training relevant to the job applied for Specify any special skills relevant to the job applied for Essential Requirements of the Position The essential requirements of the job are as follows: Able to work in 90-degree water for up to 4 hours. Able to lift up to 50 lbs. This includes moving equipment and physically assisting students in and out of the water. Able to work in a humid (degree ranges from 75-90) and noisy environment. Able to climb in and out of the pool. The essential requirements of the job for which you are applying are specified on the attached job description. Can you perform the listed essential requirements with or without reasonable accommodation? YesNo (Note: We comply with the ADA and state law and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Work / Volunteer References Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Give the names of three persons not related to you whom you have known at least one year and who can give information about your work qualifications. Reference Name Reference Address Reference Phone Reference Occupation Years Known How Known Other Besides the crime of possession of less than an ounce of Marijuana for personal use more than two years ago, Have you ever plead guilty to, "no contest" to, or been convicted of any crime? (Misdemeanor automobile moving violations are included within this question.) YesNo Describe the nature of the crime(s), when, and where convicted and disposition of the case (A conviction will not necessarily disqualify an applicant for the job applied for. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for will be considered. You may exclude any conviction where the record was judicially ordered sealed, expunged or statutorily eradicated, and any misdemeanor for which probation was successfully completed or otherwise discharged and the case has been judicially dismissed.) Have you ever committed a crime? YesNo Describe Are you currently under arrest pending trial? YesNo If yes, describe how it will affect your availability for work, if at all Have you ever stolen property or money from a former employer? YesNo Describe Have you ever damaged a former employer's property? YesNo Describe Do you carry a weapon on your person? YesNo If yes, do you have a permit to carry the weapon? YesNo Please Tell Us About Yourself (Write a summary of yourself. Include any experiences that you have had with children, babysitting, volunteering, siblings, etc.) 61844
