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Below is the Dutch Springs 2019 Employment Application for Safety Staff (Dive Professionals and Medics). All mandatory fields will be marked with an asterisk(*)

All correspondence will be through email.

It is understood and agreed upon that any misrepresentation by me in this online application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed.

I give the Employer (Dutch Springs) the right to investigate all references and secure additional information about me, if job related. I hereby release from liability the Employer (Dutch Springs) and its representatives for seeking such information and all persons, corporations, or organizations for furnishing such information.

The Employer (Dutch Springs) is an Equal Opportunity Employer. Dutch Springs does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.

This application is current for only the calendar year. At the conclusion of this time if I have not heard from Dutch Springs and still wish to be considered for employment, it will be necessary to complete this application once again.

I understand that just as I am free to resign at any time, Dutch Springs reserves the right to terminate my employment at any time, with or without prior notice. I understand that no representative of Dutch Springs has the authority to make any assurances to the contrary.

First Applicant's Name

First Name*

Middle Name

Last Name*

Phone*
First Applicant's Date of Birth*
I certify that I am 21 years of age or older
First Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
First Applicant's Signature*
Second Applicant's Name

First Name*

Middle Name

Last Name*
Second Applicant's Date of Birth*
Second Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Third Applicant's Name

First Name*

Middle Name

Last Name*
Third Applicant's Date of Birth*
Third Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Fourth Applicant's Name

First Name*

Middle Name

Last Name*
Fourth Applicant's Date of Birth*
Fourth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Fifth Applicant's Name

First Name*

Middle Name

Last Name*
Fifth Applicant's Date of Birth*
Fifth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Sixth Applicant's Name

First Name*

Middle Name

Last Name*
Sixth Applicant's Date of Birth*
Sixth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Seventh Applicant's Name

First Name*

Middle Name

Last Name*
Seventh Applicant's Date of Birth*
Seventh Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Eighth Applicant's Name

First Name*

Middle Name

Last Name*
Eighth Applicant's Date of Birth*
Eighth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Ninth Applicant's Name

First Name*

Middle Name

Last Name*
Ninth Applicant's Date of Birth*
Ninth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Tenth Applicant's Name

First Name*

Middle Name

Last Name*
Tenth Applicant's Date of Birth*
Tenth Applicant's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Applicant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 21 years of age or older
Parent or Guardian's Information

Must be 21 yrs of age or older to work in a Lakestaff position at Dutch Springs. 

You must type something in all text boxes.  If is not applicable to you, type "N/A".


Areas of Work and Discriptions


Medic-  looking for customer service oriented, National or PA certified paramedics or EMTs to assist and treat injured customers- PA or National EMT or Paramedic certification required

Lake Staff- looking for outgoing, customer service oriented dive professional (DM, AI or I) with liability insurance required to monitor lake activities and assist customers.  This is not a teaching position.


email address *
Check All Areas You are Interesting in Working (see above for descriptions) *
Lake Staff
Medic
How did you hear about employment at Dutch Springs? (Check all that apply) *
the Bethlehem Press
Family Member
Friend
the Key
Social Media (eg- Facebook, twitter,...)
Website
Other
Have you ever applied to work at Dutch Springs before?*
No
Yes
Have you ever worked for Dutch Springs in the past?*
No
Yes
Are you eligible for employment in this country*
No
Yes
Area you currently laid off and subject to recall*
No
Yes
Have you ever been bonded?*
No
Yes
Have you been convicted of a felony in the last seven (7) years?*
No
Yes

Certifications


Please list all certifications (ie- CPR, First Aid, Open Water, Divemaster,...) *

Work and Volunteer History- Starting with your current or most previous experience, fill in the fields.

Employer #1


Employer #1- Company Name *

Employer #1- Job Title
Employer #1- Still working for this employer?*
No
Yes

Employer #1 Address *

Employer #1- Phone *

Employer #1- Supervisor's name and title *
Employer #1- May we contact your supervisor for a reference?*
No
Yes

Employer #1- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #1- Summarize the nature of the work performed and the job responsibilities *

Employer #1- Start and End Dates *

Employer #2


Employer #2- Company Name

Employer #2- Job Title *
Employer #2- Still working for this employer?*
No
Yes

Employer #2- Address *

Employer #2- Telephone *

Employer #2- Supervisor's name and title *
Employer #2- May we contact your supervisor for a reference?*
No
Yes

Employer #2- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #2- Summarize the nature of the work performed and the job responsibilities *

Employer #2- Start and End Dates *

Employer #3


Employer #3- Company Name *

Employer #3- Job Title *
Employer #3- Still working for this employer?*
No
Yes

Employer #3- Address *

Employer #3- Phone Number

Employer #3- Supervisor's name and title
Employer #3- May we contact your supervisor for a reference?*
No
Yes

Employer #3- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #3- Summarize the nature of the work performed and the job responsibilities *

Employer#3- Start and End Dates *

Employer #4


Employer #4- Company Name *

Employer #4- Job Title *
Employer #4- Still working for this employer?*
No
Yes

Employer #4- Address *

Employer #4- Phone Number

Employer #4- Supervisor's name and title
Employer #4- May we contact your supervisor for a reference?*
No
Yes

Employer #4- Hourly Rate (or type in volunteer if this was not a paid position) *

Employer #4- Summarize the nature of the work performed and the job responsibilities *

Employer #4- Start and End Dates *

Educational Background

School #1


School #1- Name *

School #1- Highest Grade Completed *

School #1- Degree/Diploma/Major/Minor/Concentration *

School #1- GPA/Class Rank *

School #2


School #2- Name *

School #2- Highest Grade Completed

School #2- Degree/Diploma/Major/Minor/Concentration

School #2- GPA/Class Rank *

School #2- Clubs, Sports, Special Accomplishments *

Foreign Languages


Language *
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

Language
Aptitude (Check all that apply) *
Speak
Read
Write
N/A

References

Please list three (3) business/work/volunteer references who are not related to you and are not previous supervisors.  If not applicable, list three (3) school or personal references who are not related to you.

Reference #1


Reference #1- Name *

Reference #1- Phone Number *

Reference #1- Years Known *

Reference #1- Capacity Known *

Reference #2


Reference #2- Name *

Reference #2- Phone Number *

Reference #2- Years Known *

Reference #2- Capacity Known *

Reference #3


Reference #3- Name *

Reference #3- Phone Number *

Reference #3- Years Known *

Reference #3- Capacity Known *

List special accomplishments, publications, awards. 

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

Special Accomplishment *

List professional, trade, civic, academic or other associations and any offices held.

Exclude memberships that would reveal sex, race, religion, national origin, age, disability or other protected status.


Organization & Position Held *

Organization & Position Held *

Organization & Position Held *

Organization & Position Held *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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