Millersville University

Department of Campus Recreation

LIFEGUARD APPLICATION FORM

TERM APPLIED FOR:                                                      DATE OF APPLICATION: _____/_____/_____

Academic year ______________
Summer School _____________

NAME:  __________________________________________  Soc. Sec. # ______________________

CURRENT CAMPUS
ADDRESS:                           _____________________________________________PHONE: __________________    

E-MAIL ADDRESS            ____________________________________________________

HOME ADDRESS               _____________________________________________________________

                                                _____________________________________________________________

                                                _____________________________________________________________

HOME PHONE #                (____) _____________________

CURRENT MU CLASS     Freshman _____     Sophomore _____   Junior _____   Senior _____

ANTICIPATED GRADUATION DATE          Fall ________    Spring ________

CURRENT MAJOR            _____________________________________________________________

INDICATE THE CERTIFICATIONS YOU CURRENTLY POSESS AND EXPIRATION DATES

Lifeguard Training ______________             CPR ______________      First Aid ______________

PRIOR LIFEGUARD EXPERIENCE:

WHY DO YOU WANT TO WORK IN THIS POSITION?

REFERENCES:

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