JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Returning Lifeguard Application
This application will be kept on file at the Harvey Cedars Police Department for two years from the date of application. This application does not guarantee employment.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Last Name
*
Your answer
First Name
*
Your answer
Middle Name
Your answer
PERMANENT ADDRESS (Street, City, State, ZIP)
*
Your answer
Home Phone Number
Your answer
Cell Phone Number
*
Your answer
Driver's License Number
*
Your answer
Driver's License State
*
Your answer
Social Security Number
*
Your answer
Place of Birth (City, State, County)
*
Your answer
Date Of Birth
*
MM
/
DD
/
YYYY
Height
*
Your answer
Age as of 07/31/2019
*
Your answer
Weight
*
Your answer
Eye Color
*
Your answer
Hair Color
*
Your answer
Are you:
*
Single
Married
Seperated
Divorced
Widow
Widower
Are you a U.S. Citizen?
*
Yes
No
Have you ever been convicted of a felony or misdemeanor within the last 5 years?
*
Yes
No
If YES, please describe
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Harvey Cedars.
Report Abuse
Forms
