If you want to become a certified lifeguard and be qualified to work at any pool or beach, it’s important that you complete the Lifeguard Qualifications Approval Form. This form can help make sure that you have all of the necessary skills, knowledge, and experience needed to safely perform lifeguarding duties. In this blog post, we will take an in-depth look at the requirements for obtaining approval from a certifying organization, as well as explore how this form helps ensure safety both for certified lifeguards and the people they watch over. Read on for more information about why completing the Lifeguard Qualifications Approval Form is essential for gaining employment as a lifesaver!
| Question | Answer |
|---|---|
| Form Name | Lifeguard Qualifications Approval Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 4000Hz, recertifying, SNELLEN, nrca lifeguard license application form |
APPLICATION FOR APPROVAL OF LIFEGUARD QUALIFICATIONS
Nassau County Department of Parks, Recreation and Museums
Lifeguard Certification
Nassau County Aquatic Center, Eisenhower Park, East Meadow, NY 11554
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Physician(s) information and signatures MUST be completed in both sections of the application.
EYE EXAMINATION (To be completed by physician, ophthalmologist or optometrist)
Enter best vision test score (SNELLEN) for each eye with and without corrective lenses. Please enter numerical score only (e.g. 20/20).
UNCORRECTED
RL
CORRECTED
RL
Is it necessary for the applicant to wear corrective lenses to achieve a minimum Snellen score of 20/40 in
one eye? |
Yes |
No |
Physician’s Name:
Signature
Address:
Phone #:
License No.:
Date of Exam:
MEDICAL EXAMINATION
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Abnormal |
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Head |
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Thorax/Chest/Pulmonary |
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Abdomen/Hernia |
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HEARING STANDARDS
Hearing loss in either ear does not exceed 25db between 500 and 2000Hz, 40db to 3000Hz, and 45db to 4000Hz without correction
PASSFAIL
On the basis of your examination, do you recommend that this applicant be considered for a position of a
lifeguard? |
YES |
NO |
Physician’s Name:
Signature
Address:
Phone #:
License No.:
Date of Exam:
I HEREBY ACKNOWLEDGE THAT FALSIFICATIONS OF ANY PART OF THIS APPLICATION WILL AUTOMATICALLY RESULT IN REVOCATION OF ANY LIFEGUARD CERTIFICATION ALREADY HELD AND A
Signature of Applicant:
Date:
INSTRUCTIONS FOR COMPLETING APPLICATION
1.All first time applicants are required to apply in person. The office will process applicants between the hours of 9 AM – 3:45 PM, Tuesday
through Friday only. All applicants should call
2.Have your physician(s) enter the results of your medical, eye and hearing examination on the reverse side of this form. Physician(s) information and signatures must be completed in both sections of the application. No copied or faxed signatures will be accepted. The examination is valid for one year. A medical doctor must perform the medical and hearing examination.
3.First time applicants MUST apply in person, and provide their original Basic Lifeguarding or Lifeguard Training certification.
4.If you are recertifying, please bring your current or expired card. You must pass the recertification test within one month of the expiration date.
5.Sign your name in the space provided on the reverse side of this form.
6.All applicants must submit a check or money order [NOT CASH] in the amount of $100 payable to Treasurer of Nassau County.
7.Please be advised there may be a
8.Please be advised, the application must be 100% complete in order for an applicant to be processed and a test date to be given. There are NO exceptions!