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4. Personal Data
6. First Name*
7. Last Name*
8. Middle Initial
9. Date of Birth*
   Date of Birth
11. Email Address
12. Phone Number*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Do you hold a valid Driver's License?*

    1. Yes
    2. No
20. What type of license?*
24. Position Information
26. Please state the position or type of employment you are applying for.*
28. What age group(s) do you prefer to work with?

    1. Preschool
    2. Pre-Teen
    3. Teenagers
    4. Adults
    5. Senior Adults
30. When are you available for employment?
32. Summer

    1. Morning
    2. Afternoon
    3. Evening
33. Fall

    1. Morning
    2. Afternoon
    3. Evening
34. Winter

    1. Morning
    2. Afternoon
    3. Evening
35. Spring

    1. Morning
    2. Afternoon
    3. Evening
37. Weekends

    1. Morning
    2. Afternoon
    3. Evening
39. Do you hold a First Aid Card?

    1. Yes
    2. No
40. Do you hold a CPR Card?

    1. Yes
    2. No
42. If so, what is the expiration date(s)?
44. If you are certified in either of these courses, please attach a copy of your cards to this application.
46. Please list skills, teaching abilities and other talents that may apply to your desired position.
48. Are you applying to be a lifeguard and/or water safety instructor?*

    1. Yes
    2. No
49. Do you hold an active Lifeguard Training Certificate?

    1. Yes
    2. No
50. Do you hold an active W.S.I. Certificate?

    1. Yes
    2. No
51. Do you hold an active Waterfront Module Certificate?

    1. Yes
    2. No
53. Please list expiration dates for any of these certificates.
55. If you are certified in any of these courses, please attach a copy of your card(s) to this application.
59. Education
61. School Name
62. Address
64. City
65. State
66. Zip Code
68. Years Attended
    Years Attended Start Date

    —

    Years Attended End Date
69. Degree
70. Major
74. School Name
75. Address
77. City
78. State
79. Zip Code
81. Years Attended
    Years Attended Start Date

    —

    Years Attended End Date
82. Degree
83. Major
87. School Name
88. Address
90. City
91. State
92. Zip Code
94. Years Attended
    Years Attended Start Date

    —

    Years Attended End Date
95. Degree
96. Major
100. Past Employment
     Begin with the most recent.
102. Employer
103. Supervisor
105. Address
107. City
108. State
109. Zip Code
111. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
112. Position Held
114. Reason for Leaving
118. Employer
119. Supervisor
121. Address
123. City
124. State
125. Zip Code
127. Dates Employed
     Dates Employed Start Date

     —

     Dates Employed End Date
128. Position Held
130. Reason for Leaving
134. References
     Include people who can furnish information as to character, training and experience.
136. First Name
137. Last Name
139. Address
141. City
142. State
143. Zip Code
145. Position
146. Phone Number
150. First Name
151. Last Name
153. Address
155. City
156. State
157. Zip Code
159. Position
160. Phone Number
164. First Name
165. Last Name
167. Address
169. City
170. State
171. Zip Code
173. Position
174. Phone Number
178. The Town of Manlius Recreation Department does a background check on all employees. Please sign here to give consent to a background check.
180. Name*
181. Date*
     Date
183. Legal Residence
     Fill in the names of the City or Village, School District, and State of which you are a legal resident.
185. School District*
186. City/Village*
187. State*
Leave This Blank:


189. 1. Receive an email copy of this form.
190. Email address

     This field is not part of the form submission.

191. Submit

* indicates a required field