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Chabot Swim Club Lifeguard Application


Name ___________________________   Date of Birth_________________

Address __________________________ City____________ Zip_________

Home Phone_________________      Cell phone______________________


School __________________________________ Current Grade________

Previous job experience __________________________________________________________________________________________________________________________

Life Guard Certification       yes ___no ___       Expiration Date_______________

CPR certification   yes ___ no___       Expiration Date____________________

If not certified, when are you scheduled for certification? _____________________________________________________________

When can you start working? _____________________

Do you have scheduling conflicts__________?

What & Why (summer practices, other jobs, camps, etc.)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

What dates do you expect to not be available to work? _______________________________________________________________________________________________________________________________________________________________________________________

The above information is correct to the best of my knowledge.


I understand that by applying for and accepting a job as a lifeguard at the Chabot Swim Club:

     I am agreeing to perform a job that includes protecting the lives and safety of both the children and adults that come to enjoy the club. I understand that when I am on duty, I will be responsible for supervising swimmers, minimizing dangers, educating facility users about safety, enforcing rules and regulations, providing assistance, and, if necessary, performing rescues. I understand the importance of my duties as a certified lifeguard to protect and save lives.

     I also understand that my job will include keeping facilities clean at all times, including picking up trash, cleaning the pool, and cleaning bathrooms.  I also understand that by accepting the job, I am committing to it for the pool season, which runs through the end of August, then weekends through October.




Reviewed at hiring __________ (initial)

The following documents will be required at hiring:

1.    Completed application

2.    Tax forms: I9 and W4 /Work Permit if under 18 years old

3.    Copy of driver’s license or ID

4.    Copy of CPR card

5.    Copy of Lifeguard Certification


I, ______________________________________, understand that if I fail to return the Chabot Swim Club pool keys by November 10, 2014, I may be assessed a $50.00 key fee.


Return via email to:

Do you need to update your membership information? Click on the link below, fill out the form and email it to

Chabot Swim Club Member Info 2018.docx

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