MISQUAMICUT FIRE DISTRICT

                                              APPLICATION FORM

                                                                                        Revision 0 ‹ 01/16/03

 

 

NAME: _______________________________________________________________________________

                                             Last                                                 First                                                 M.I.

 

ADDRESS: ___________________________________________________________________________

                                             Street

 

______________________________________________________________________________________

                                             Town                                               State                                                Zip

 

TELEPHONE: _________________________ SOCIAL SECURITY #: __________________________

 

PARENT/GUARDIAN/SPOUSE CONTACT INFORMATION:

 

NAME: ________________________________________ RELATIONSHIP: ______________________

              

              

ADDRESS: ___________________________________________________________________________

                                             Street

 

______________________________________________________________________________________

                                             Town                                               State                                                Zip

 

EMERGENCY PHONE NUMBER: ______________________________________________________

                                                                          

-         APPLYING FOR:

q       BEACH MANAGER/ASSISTANT BEACH MANAGER

q       LIFEGUARD- RI CERTIFICATION #_______________EXPIR. DATE: __________

q       BEACH ATTENDANT

q       RECREATION COMPLEX ATTENDANT

q       TRACTOR OPERATOR

q       OTHER _______________________

-         STATE EXPERIENCE FOR THE POSITION APPLIED FOR (USE BACK IF MORE SPACE IS NEEDED:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

-         IF YOU ARE UNDER AGE 18 CAN YOU PROVIDE
REQUIRED PROOF OF ELIGIBILITY FOR WORK?                                  [ ] Yes          [ ] No

-         CAN YOU COMMENCE WORK MEMORIAL DAY WEEKEND?             [ ] Yes          [ ] No

-         CAN YOU WORK THROUGH LABOR DAY WEEKEND?                        [ ] Yes          [ ] No

 

SIGNATURE: ____________________________________________       DATE: _____________________

 

-        PLEASE COMPLETE AND RETURN TO:       MISQUAMICUT FIRE DISTRICT

                                                                                          ATTENTION: MODERATOR

                                                                                          P.O. BOX 2962

                                  WESTERLY, RI 02891

                                                                                          BY APRIL 1ST