Name *

First Name

Last Name

Permanent Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell / Primary Phone # *

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Position Desired *

Lead Instructor

Sailing Instructor (age 16+)

Junior Instructor

Availability *

Full Time

Part Time

US Sailing Courses: *

Sailing Counselor

Level 1

Level 2

I plan to take courses (describe below)*

Have you ever been trained/certified in any of the following safety protocols: *

American Red Cross: First Aid/CPR/AED

Stop the Bleed Training

Other (describe below)*

Reference #1 *

First Name

Last Name

Reference #1 Phone *

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Reference #2 *

First Name

Last Name

Reference #2 Phone *

(###)

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Reference #3 *

First Name

Last Name

Reference #3 Phone

(###)

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Electronic Signature *

I certify that the facts contained in this application are true and complete to the best of my knowledge. I give permission for any inquiries to establish qualifications, experience, and character. This may include inquiries from past/present employers.