Please fill out the following information and we will be in touch ASAP. Employment Opportunities Applicant InfoName First Last Birth Date MM slash DD slash YYYY Current AgeCell PhoneEmail Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a member or planning to become a member of the Middletown Swim Club for the 2026 Season? Yes No PositionPosition(s) applying for: Part-time Lifeguard (cert required) Pool Manager (age 18+) Summer Camp Counselor (age 18+) Part-Time Groundskeeper (age 18+) Swim Lesson Instructor (16+ with Experience) CertificationsCertification/License UploadsLifeguard CertificationUpload a PDF of your lifeguard or Aqua Aerobics certification here.Max. file size: 10 MB. Certification DateEnter either the expiration date of your current lifeguard certification or the completion date of a future certification. MM slash DD slash YYYY Employment HistoryEmployment History & References Personal References (asst manager position only): name and phone numberCurrent or Most Recent Employer First Last Employer Phone NumberEmployer Email Please List ReferencesReference NameReference PhoneReference Email Acknowledgement*By checking the box below I understand that, as a condition of my employment, I will adhere to the requirements stated in the Procedure Manual and the Rules and Regulations of the organization. I understand that any violation of these policies and rules may result in termination of employment. I agree to the aboveOrder Token