Splash Pad Attendant Opening -

Application Information

First Name *

Last Name *

Permanent Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Home Phone Number

Cell Phone Number

Email Address *

Social Security # *

Are you 18 years or older *YesNo

Are you a citizen of the United States,, by either birth or naturalization? *YesNo

Criminal Activity

Have you ever been indicted, arrested or charged with a crime by a law enforcement agency? *YesNo

If yes, list the date(s), reason(s), agency and disposition of incident.

Have you ever been convicted of a crime, placed on court ordered community supervision or probation? *YesNo

If yes, list the county/state, date, reason, agency and disposition of incident.

Have you been involved in any court action, civil, or criminal? *YesNo

If yes, list the date, reason, agency and disposition of incident.

Have you been issued a citation for a traffic/ non-traffic violation? *YesNo

If yes, list the date(s), violation(s), city/state(s) and disposition.

Education

High School Attended

High School Location

High School Dates Attended

Diploma ReceivedYesNo

College Attended

College Location

College Dates Attended

Diploma ReceivedYesNo

Other Education Attended

Other Education Location

Other Education Dates Attended

Diploma ReceivedYesNo

Previous Employment

Please list below your last two employers, starting with the most recent.

Previous Employer Name #1

Employer Address

Employer Contact Number

Dates of Employment

Position Held

Reason for leaving

Previous Employer Name #2

Employer Address

Employer Contact Number

Dates of Employment

Position Held

Reason for leaving

References

List two persons who know you well enough to provide current information about you. Do not list relatives. Please include complete mailing addresses and phone numbers.

Reference #1 Name

Reference Address

Reference Phone Number

Reference Years Known

Relationship with Reference

Reference #2 Name

Reference Address

Reference Phone Number

Reference Years Known

Relationship with Reference

Applicant Signature *

Date Application Completed *

Splash Pad Attendant Opening

Open Splash Pad Attendant Position

Online Application

Application Information

Criminal Activity

Education

Previous Employment

Please list below your last two employers, starting with the most recent.

References

List two persons who know you well enough to provide current information about you. Do not list relatives. Please include complete mailing addresses and phone numbers.

Contact Information

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