Lifeguard Application Form

Lifeguard Application Details

Please fill out your information below.
Personal Information
Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemalePrefer not to sayOther (please state)
Do you identify as Aboriginal and/or Torres Strait Islander?*

YesNoPrefer not to say
Nationality*
Region Interested in Lifeguarding In*

North QueenslandTownsvilleMackayWide Bay CapricornNoosaSunshine Coast North (Alex Headlands - Coolum North)Sunshine Coast South (Mooloolaba - Golden Beach)South East QueenslandSouth BankSouth Bank First Aider
Please Note:

You have selected you are interested in working at South Bank as a First Aider, this only requires First Aid (FA) and Advanced Resuscitation Techniques (ART), training will be provided for suitable candidates.
Please select which SEQ area you are interested in:

Work Availability*

	General	School Holidays
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Postal Address is

Same as above
Postal Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*
E-mail*
example@example.com
What Surf Life Saving Club are/were you apart of?
Are you currently employed by Surf Life Saving Queensland?*

YesNo
If yes, please specify role:
Medical History
Have you sustained or do you carry any illness or limiting disability that may affect your ability to complete any physical components of the training and/or duties required?*

YesNo
Do you suffer from any known medical condition?*

YesNo
If yes, please provide details:
NOTE: You may be required to supply a medical certificate prior or during your employment as a Lifeguard.
Emergency Contact Details
Emergency Contact Name*
Emergency Contact Phone Number *
Emergency Contact Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Relationship*
Reference Checks

Please provide 2 referees SLSQ have permission to contact
Referee 1*

First NameLast Name
Email*
example@example.com
Contact Number *
Relationship to you*
Referee 2*

First NameLast Name
Email*
example@example.com
Contact Number*
Relationship to you*
Experience
Please specify any relevant experience*
Please provide any other additional information that may be relevant *
Required Documentation
Do you currently have any of the following qualifications

SLSA Bronze/ Cert IIFirst AidAdvanced Resuscitation Techniques (ART)Silver Medallion Beach Management (SMBM)Marine/Jet Ski Licence
Blue Card / Reference No.*
Paid (P) Blue Card only
Expiry Date

DayMonthYear
If applicable
Drivers Licence No.*
Expiry Date*

DayMonthYear
Drivers Licence No.*
Attachments
Please attach a copy of your:*

Blue Card / Confirmation of lodgementDrivers LicenceResume
Cancelof
Disclaimer

This is an application only, you are not employed by SLSQ until you receive a contract of employment.
Should be Empty:

Lifeguard Application Details

Personal Information

Please Note:

Medical History

Emergency Contact Details

Reference Checks

Experience

Required Documentation

Attachments

Disclaimer