DCLSA Employment Application Updated 4.21.21

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Email *

Full Name *

Street Address *

City / Town Address *

State Address *

Zip Code *

Primary Phone Number *

Alternate Phone Number (or write none) *

Drivers License State and Number (or write none) *

If under 18, are you willing to secure a work permit from the state of Maryland and submit it to the DCLSA House Chair as soon as possible? *

YES

I am 18 or older

Have you had a Covid - 19 Vaccination? (For applicants 18 and over) *

YES

Not yet, but I intend to prior to employment

I am under 18

Other:

Emergency Contact (First and Last Name) *

Emergency Contact Relationship to You *

Emergency Contact Primary Phone Number *

Emergency Contact Address (or write "same" if the same address as yours) *

Seasonal / Part Time Position Desired *

Kitchen / Food Service

Lawn Care

Dinghy Driver (Must have valid State of Maryland Boater's License)

Other:

Required

Please provide any relevant experience or information you believe is relevant for your application (such as prior food-related experience or sailing experience) *

I hereby certify that the information contained herein is true and correct. (Please type your initials). *

I authorize DCLSA to contact any prior employer or educational institution about my prior employment, attendance or grades.(Please type your initials). *

I understand that any employment offered to me by DCLSA is “at will” and can be terminated at any time. (Please type your initials). *

Please enter today's date *

YYYY

A copy of your responses will be emailed to the address you provided.

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