[PDF] [PDF] lifeguard application & registration form - First Security Group





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[PDF] lifeguard application & registration form - First Security Group

FIRST SECURITY GROUP CERTIFICATION DEPARTMENT LIFEGUARD APPLICATION REGISTRATION FORM Doc No : FSG CERT 15 07 03 Rev : 3 Date: 15 01 17



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:

FIRST SECURITY GROUP

CERTIFICATION DEPARTMENT

LIFEGUARD APPLICATION & REGISTRATION FORM

Doc. No.:

FSG.CERT.15.07.03

Rev.: 3

Date:

15.01.17

FSG.CERT.15.07.03

Rev. 3 Date: 15.01.17

LIFEGUARD ASSESSMENT APPLICATION & REGISTRATION FORM

REGISTRATION NO: ________________________

POOL LIFEGUARD SHALLOW WATER LIFEGUARD

BEACH LIFEGUARD WATER PARK LIFEGUARD

LIFEGUARD TRAINER LIFEGUARD SUPERVISOR

CANDIDATE INFORMATION

1 Name as in Passport:

2 Date of Application:

3 Gender: Male Female 6 Contact Details:

4

Date of Birth:

d d m m y y Mobile: _____________________________________________ Landline: _____________________________________________ Email: _____________________________________

Primary Emergency Contact Person:

1 _____________________________________________________

2 ___________________________________________

5

Organization/Centre:

________________________________________ Declaration of physical fitness: (Tick or ) Important Personal Undertaking (Tick or )

I am a strong swimmer

I have undertaken appropriate training both

Practical/Theoretical to be able to take the lifeguard assessment I am physically and mentally fit for the Assessment

I have no communicable disease

I am not an Asthma Patient

I do not suffer from Heart conditions

I do not suffer from any allergies

I agree to FIRST AID treatment during an emergency by any locally certified First Aider and DCAS.

I am aware that:

I can ask for an Interpreter if required

I should behave appropriately as instructed

I should dress appropriately as instructed

I can be disqualified for any act of indiscipline

I must follow the emergency procedures as informed by the Examiner/ Assessor /Invigilator I can appeal or complaint should I not be satisfied with the assessment/ outcome/ certification I should read and follow the Lifeguard Code of Ethics and Substance Abuse Policy of Dubai Municipality provided to me during registration

Declaration of Compliance (Tick or )

The documents and information provided by me are true and to the best of my knowledge.

I have reviewed and fully understand the certification requirements and the Assessment criteria and agree

to comply.

Candidate Signature & Date:

Authorized Admin.

Signature:_____________________ Date: _______________

Verified by:

CDM Signature: _______________ Date: _______________ Affix photographquotesdbs_dbs17.pdfusesText_23
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