EmailMe Form - Town of Camillus Parks & Recreation Department

hidden field not seen by applicant - used for email notification

Please read:

It is recommended that you first scroll through this application and identify/understand our information requests. (additionally you could print the document)

We do NOT provide the capability to SAVE the application and complete later.

Position Applying For

Select from the availabe positions.

Date available *

MM / DD / YYYY

Please provide your first available date, if immediate then choose todays date.

Personal Information

...........................................................................................................................

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email

Drivers License Number

Birth Date

MM / DD / YYYY

This information is used to determine minimum age for equipment operation

Gender *

Female

Male

not given

Education and Certifications

...........................................................................................................................

High School Name *

City/Town/County

Major

ex: Regents

Graduation Date *

MM / DD / YYYY

If the actual date of graduation is NOT known OR is in the FUTURE, choose June 15th of the YEAR of graduation/anticipated graduation.

Check any of the following you have completed and hold a CURRENT certification

Certifications

First Aid Certification expires

MM / DD / YYYY

Life Guard Certification expires

MM / DD / YYYY

CPR Cert expires

MM / DD / YYYY

Water Front Module Certification expires

MM / DD / YYYY

Water Safety Instructor Certification expires

MM / DD / YYYY

Additional Certification 1

Cert 1 Expires

MM / DD / YYYY

Additional Certification 2

Cert 2 Expires

MM / DD / YYYY

Additional Certification 3

Cert 3 Expires

MM / DD / YYYY

Employment Information

Pease provide previous employment, references and relevant experience
...........................................................................................................................

Have you been employed previously by this department? *

Yes

No

If YES above, please provide Title

and From Date

MM / DD / YYYY

To Date

MM / DD / YYYY

Please list any relatives employed by the
Town of Camillus:

References

Please provide three (3) references

First Reference Name

First Last

First Reference Address

Street Address City State / Province / Region Postal / Zip Code Country / Region