Willow Springs Water Park 
Employment Application
(please print)

General Information
Name:___________________________________________________________
Address: ________________________________________________________
City:  ______________________  State: ___________  Zip Code: ___________
Phone Number:  ____________________  Social Security:  ________________
Email Address:  ___________________________________________________
Date of Birth:  _________________________________  Age:  ______________

Education
Last School Attended:  ______________________________________________
Years Attended:  __________________________________________________
CPR Certification:  _  Yes  _ No  Expiration Date:  ________________________
Lifeguard Certification:  :  _  Yes  _ No  Expiration Date:  ___________________
List any foreign languages that you speak:  ______________________________

Previous Employment (If you have no employment history, please list three personal references with phone numbers on the back of this form.) 
Company:  _______________________________________________________
Phone Number:  ______________________  Supervisor:  _________________
Dates of employment:  ____________________ - ________________________
Duties:___________________________________________________________________________________________________________________________________________________________________________________________
Company:  _______________________________________________________
Phone Number:  ______________________  Supervisor:  _________________
Dates of employment:  ____________________ - ________________________
Duties:___________________________________________________________________________________________________________________________________________________________________________________________

Other Activities
List any other responsibilities or activities in which you are involved in the summer and give an explanation of how this would affect your time off.
________________________________________________________________________________________________________________________________________________________________________________________________

I certify the information contained in this form is truthful and accurate.
Signature:  _____________________________  Date:  ___________________

Please forward this application by mail to Willow Springs Water Park, 3903 Willow Lake Road, Little Rock, AR  72206 or by email attachment to:  davidratliff1@aol.com