Form - Valley Center Recreation Commission

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FormVCRC2021-08-17T17:12:45+00:00

Applicant Information

Date / Time

First Name *

M.I *

Last Name *

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Birthday

Position Applied For *

Education

High School : *

Address :

From : *

To : *

Did you Graduate ? *

Diploma :

College

Address :

From :

To :

Did you Graduate ?

Diploma :

Other :

Trade school, certification courses, etc.

Address :

From :

To :

Did you Graduate?

Diploma or Certification :

References

Please list all three references.

Reference—Full Name :

Relationship :

Company :

Phone :

Address :

Reference—Full Name :

Relationship :

Company :

Phone :

Address :

Reference—Full Name :

Relationship :

Company :

Phone :

Address :

Previous Employment

Job History—Company : *

Job Title : *

Supervisor : *

Phone :

Address :

Reason for Leaving : *

Job History—Company :

Job Title :

Supervisor :

Phone :

Address :

Reason for Leaving :

Job History—Company :

Job Title :

Supervisor :

Phone :

Address :

Reason for Leaving :

Additional Information

Please check the following that pertain to your background:

Ball Diamond Maintenance
Lifeguard
Lifeguard Training Certified
Water Safety Instructor Certified
Swim Aid
Cash Register
CPR Certified ( current)
First Aid Certified (current)
Umpire Experience/clinics
Youth Sports Supervision
General Recreation Work

Other background experience : *

Additional skills or qualifications : *

Do you have any activities that would restrict ? *

Do you have any activities that would restrict you from performing the job requirements of the Recreation Commission (other job, school, weddings, vacations, camps, etc.)? If yes, please specify in detail.

Are you able to work weekends? *

Holidays ? *

Late nights? *

Do you have a valid driver's license? *

Do you have reliable transportation? *

Do you have allergies?

If yes, please specify

Do you have any physical limitations?

If yes, please specify.

Additional information not included above *

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Date / Time *

117 N Park Ave
Valley Center, KS 67147

Contact Us

Hours:
Monday through Friday
8 a.m. - 5 p.m.

(316)755-7345
valleyrec@vcrc.info

© 2022 Valley Center Recreation Commission | All Rights Reserved