LONG BEACH TOWNSHIP BEACH PATROL 6805 Long Beach Boulevard, Brant Beach, NJ 08008

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1 LONG BEACH TOWNSHIP BEACH PATROL 6805 Long Beach Boulevard, Brant Beach, NJ Protecting 12 Miles of Ocean Beach on Long Beach Island Dear Applicant: We thank you for your interest in obtaining a position as a beach badge checker for Long Beach Township. The deadline for all required documents is May 1, The following documents are to be submitted by this date: 1. Application 2. CPR Course Registration form (Supervisor/Asst. Supervisor) 3. Physical 4. NJ State Police Background form ( ages 18 and over ) will be sent to applicant upon receipt of application. Deadline for Background form is May 15, W-4 6. I-9 w/proper ID 7. New Jersey Working Papers completed (ages [18 if still in High School]) Those interested in taking one of our CPR courses can sign up using the attached form. This course is not mandatory. You will be notified by mail, or phone if you are being offered a position. You can contact the Beach Patrol office at (609) , if you have any questions. Sincerely, Tracey A. Schmidt Lifeguard Coordinator Josh Bligh Lifeguard Coordinator Phone Fax (609) (609)

2 LONG BEACH TOWNSHIP BEACH PATROL 6805 Long Beach Boulevard, Brant Beach, NJ Protecting 12 Miles of Ocean Beach on Long Beach Island 2017 New Beach Badge Checker Application (6/17/17-9/4/17) Application is computer friendly Last Name First Name MI Sex Date of Birth M F Permanent Address Summer Address Permanent Phone # Cell Phone # Summer Phone # Address First Date Available to Work Last Date Available to Work Unavailable Dates to Work High School Graduated Y N Year College Graduated Y N Year ARC Emergency Medical Response? ARC CPR Certification? LBTBP LIT Certification? Expires Expires Level Date Y N Y N Beach Badge Checking Experience? Date(s) of Year(s) Worked Position Patrol Other certifications and previous beach badge checking experience. List dates and locations. Continue on next page if necessary. Emergency Contact #1 - Name / Relation Address Phone # Emergency Contact #2 - Name / Relation Address Phone # 1. Do you have a history of medical problems which would prohibit you from performing Y N the duties of your job? If you answered yes to questions 1, 2 2. Have you ever been convicted of a crime? Y N or 3, please explain on the nextpage. If 3. Have you ever been discharged from a position? Y N you have a history of learning disabilities, please state. ETHNICITY (Please choose from list below) RACE (Please choose fron list below) Phone Fax (609) (609)

3 I state that the above information is true and correct to the best of my knowledge. Signature of Applicant (Electronic signature accepted) Date Signature of Parent or Guardian (for minors only) (Electronic signature accepted) Date Incomplete applications will not be accepted. Must be completed in full. Other dates unavailable: Additional Information: Other Certifications: Explanation for questions 1, 2 or 3:

4 2017 Health, Safety Course and Swim Test Registration Form Class Location: Multipurpose Room, 2nd Floor 6805 Long Beach Boulevard, Brant Beach, NJ Class Limit: 25 Students (First Come Basis) Cost: $ for CPR (if you need to take EMR - DO NOT SIGN UP FOR CPR) $ for EMR (includes CPR at no additional cost) Checks are to be made payable to LBTBP ARC Cert. Acct. PAYMENT MUST ACCOMPANY REGISTRATION. Contact: Tracey Schmidt at (609) if you have any questions. Personal Information Name: Date of Birth: Address: Home Phone: Cell Phone: Previous patrol assignment: LL NB BB BHC SB H New Lifeguard Beach Badge Checker Note: Emergency Medical Response must be re-certified every 2 years. CPR must be re-certified annually. Click on the box that corresponds with the course(s) you wish to take. CPR/AED/AEO with PDT Full Course #1 - Friday, February 17, 2017 Full Course #2 - Sunday, March 12, 2017 Full Course #3 - Saturday, April 8, 2017 Full Course #4 - Tuesday, April 18, 2017 Full Course #5 - Monday, May 15, 2017 Full Course #6 - Saturday, May 20, 2017 Full Course #7 - Monday, May 22, 2017 Full Course #8 - Saturday, June 3, 2017 OR Emergency Medical Response (includes CPR) Sundays - March 12, 19, 26, April 2, 2017 Easter - April 18-21, 2017 Mon -Thurs - at BP Headquarters Saturdays - April 8, 15, 22, 29, 2017 Weekday #1 - May 15-18, 2017 Mon & Wed - Tues & Thurs - 12pm - 8pm Weekday #2 - May 22-25, 2017 Mon & Wed - Tues & Thurs - 12pm - 8pm Instructor - TBA (LIMIT 10 PARTICIPANTS) OLTC (Ocean Lifeguard Training Course) OLTC #1 - June 12-16, 2017 Monday - Friday OLTC #2 - June 19-23, 2017 Monday - Friday Applicants must pass the swim test and Emergency Medical Response to participate in OLTC. ARC CPR Instruction Book is available to download from our website on Employment link. 500M USLA Swim Test (10 minutes or less) St. Francis Aquatic Center - By Appointment (choose one) Saturday, May 6, :30pm Saturday, May 13, :30pm Saturday, May 20, :30pm Saturday, May 27, :30pm Bayview Park Saturday, May 27, am Sunday, May 28, am NO PHYSICAL FORM - NO SWIM TEST NO EXCEPTIONS

5 MEDICAL or OSTEOPATHIC PHYSICIANS DOCUMENTATION of the PHYSICAL HEALTH of an INDIVIDUAL APPLYING for EMPLOYMENT/RE-EMPLOYMENT with the LONG BEACH TOWNSHIP BEACH PATROL as a SEASONAL BEACH BADGE CHECKER Please execute below where indicated that you have seen, treated and/or examined prior to his/her commencing employment with Long Beach Township. This individual will begin, effective, as a Beach Badge Checker with tasks that mainly involve: Walking for extended periods of time on the beach in varying weather conditions. Upon completion of this form, please return ASAP to the Long Beach Township Beach Patrol so that we may expedite his/her employment. Possesses ability to start work Does not possess ability to start work Date: Signature of Physician Date Phone # Address City State Zip Long Beach Township Beach Patrol 6805 Long Beach Boulevard Brant Beach, NJ Telephone: (609) Fax: (609) *This form must be stamped by the physician s office doing the exam using their office/business stamp and/or notarized.

6 primepoint Employee Direct Deposit Enrollment/Change Form Company Name: LONG BEACH TOWNSHIP PLEASE READ AND SIGN BEFORE SUBMITTING I hereby authorize my employer to initiate credut entries and initiate, if necessary, debit entries and adjustments for any credit entries to my account at the financial institution indicated on this form. This authorization is to remain in full force and effect until Primepoint has received written notification from me, and Primepoint and Bank have a reasonable opportunity to act on it. Employee Name: Employee Signature: Social Security Number: Date: NEW ACCOUNT INFORMATION - Sample check below identifies the routing and account numbers Bank Name: Routing #: I wish to: (check one) Deposit Entire Net into account Deposit % into account Deposit $ into account Account #: Account Type: (check one) Checking Savings HSA REVISE / REMOVE EXISTING ACCOUNT Bank Name: Routing #: I wish to: (check one) Deposit Entire Net into account Deposit % into account Deposit $ into account Account #: Account Type: (check one) Checking Savings HSA MEMO Routing Number (Exactly 9 digits) Bank Account Number Instructions: Include a voided check or bank specification sheet for each account. DO NOT SEND A DEPOSIT SLIP. **DO NOT USE DEBIT ACCOUNT NUMBER FOR BANK ACCOUNT NUMBER.**

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