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2. Lifeguard/WSI Application
4. ASC/City of Sioux Center
6. 770 7th Street NE, Sioux Center IA 51250
8. E-mail: asc@allseasonscenter.org
   Phone: (712) 722-4386

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12. Personal Data:
14. Name:*
16. Home Address:*
18. Phone Number(s):*
20. Date of Birth:*
21. E-mail Address:*
23. Parent's Email address if under 18
25. Who referred you to work at the ASC?
27. Position you are applying for:*

    1. Lifeguard
    2. Swim Instructor
    3. Shift Supervisor
29. Training:
31. Please provide a copy of the following certifications.
33. Date of Lifeguard Training:*
35. Lifeguard certification copy
37. Date of CPR/First Aid Training:*
39. CPR/First Aid certification copy
41. Are you WSI certified?*

    1. Yes
    2. No
43. If yes, date of training:
45. List any other specialized training you may have: (Please provide a copy of your current certifications)
47. Other certification copies:
49. Working Hours:
51. How many hours a week would you be willing/interested in working?
53. Would you be willing to work occasional Sunday afternoons?*

    1. Yes
    2. No
55. List your preferred hours of work:
57. Employee Questions:
59. Comment on why you want to work as a summer staff member at the All Seasons Center and what qualities you have that would make you a good (great) employee?*

61. ---
63. Name:*
64. Date:*
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit Submit and Print

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