Mt. Horeb Recreation Department

222 East Front Street, Mt. Horeb, WI 53572

Seasonal Employment Application

Employment for (circle one or more):      Spring             Summer                Fall                   Winter

POSITION FOR WHICH YOU ARE APPLYING_____________________________________________________

NAME___________________________________________________________________________________

ADDRESS________________________________________________________________________________

CITY__________________________ STATE___________________ ZIP______________________________

HOME PHONE_________________________WORK/SCHOOL PHONE________________________________

CELL PHONE__________________________EMAIL______________________________________________

ARE YOU AT LEAST 16 YEARS OF AGE?                 YES______ NO______

ARE YOU PRESENTLY A FULL TIME STUDENT?    YES______ NO______

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IF YES CIRCLE ONE:   HIGH SCHOOL                  COLLEGE                                    VOCATIONAL SCHOOL

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EDUCATION

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NAME OF HIGH SCHOOL_______________________________YEAR OF GRADUATION____________________

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NAME OF COLLEGE___________________________________YEAR GRADUATION_______________________

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MAJOR COURSE OF STUDY (if applicable)_______________________________________________________

 

JOB EXPERIENCE

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      EMPLOYER                                                     JOB DESCRIPTION                                                      DATES

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1.________________________________________________________________________________________

2.________________________________________________________________________________________

3.________________________________________________________________________________________

FIRST AID/SPECIAL TRAINING

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HAVE YOU HAD ANY FIRST AID TRAINING?    Yes_____    No_____

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IF YES, CHECK THE COURSES YOU HAVE COMPLETED

 

_____STANDARD FIRST AID CERTIFICATE DATE RECEIVED____________ DATE EXPIRED____________

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_____LIFEGUARD DATE RECEIVED____________ DATE EXPIRED____________

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_____CPR CERTIFICATE DATE RECEIVED____________ DATE EXPIRED____________

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_____WSI DATE RECEIVED____________ DATE EXPIRED____________

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_____FIRST AID INSTRUCTOR CERTIFICATE DATE RECEIVED____________ DATE EXPIRED____________

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_____OTHER__________________________________________

 

PLEASE LIST ALL ACTIVITIES THAT YOU HAVE SUPERVISED, OFFICIATED, OR ACTIVELY PARTICIPATED IN THAT PERTAIN TO THE JOB YOU ARE APPLYING FOR.

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1.______________________________________    6.______________________________________

2.______________________________________    7.______________________________________

3.______________________________________    8.______________________________________

4.______________________________________    9.______________________________________

5.______________________________________   10.______________________________________

NOTE: PLACE AN "*" BEHIND ANY ACTIVITY THAT YOU HAVE SUPERVISED OR OFFICIATED.

GENERAL INFORMATION

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                                                    DO YOU PLAN TO ATTEND SUMMER SCHOOL?      YES_____ NO_____

                                                    ARE YOU AVAILABLE FOR MORNING WORK?         YES_____ NO_____

                                                    ARE YOU AVAILABLE FOR AFTERNOON WORK?    YES_____ NO_____

                                                    ARE YOU AVAILABLE FOR EVENING WORK?            YES_____ NO_____

WHAT DAYS ARE YOU AVAILABLE? _________________________________________________

WHAT HOURS ARE YOU AVAILABLE? ________________________________________________

I WILL BE AVAILABLE FROM (Month/Day)_____________________TO (Month/Day)____________________

DO YOU PLAN A VACATION? YES_____ NO_____ IF YES, WHEN?___________________________________

WHAT WORK DO YOU FEEL YOU ARE MOST QUALIFIED FOR OR ADAPTED TO?_____________________________________________________________________________________

________________________________________________________________________________________

REFERENCES

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PLEASE LIST THREE CHARACTER REFERENCES WHO ARE NOT RELATIVES:

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1._________________________________________________ PHONE_______________________________

2._________________________________________________ PHONE_______________________________

3._________________________________________________ PHONE_______________________________

By providing the information above, you allow the Mt. Horeb Recreation Department to check references.

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SIGNATURE______________________________________DATE OF APPLICATION____________________