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Contents : 2011 HMBYC YOUTH SAILING PROGRAM INSTRUCTOR APPLICATION I. PERSONAL DATA: Last Name First Name Address City State Zip E-mail: Telephone: Residence: ( ) - Cell/Business: ( ) - Birth date: / / Have you ever been convicted of a felony Check one: No Yes . If yes please explain. II. SAILING EXPERIENCE: l. How and where did you learn to sail Include at least one contact name and number if possible. 1 2. What types of small boats keelboats and multi-hulls have you skippered or crewed on. Type of Boat Role # Years Where 3. Explain your experience with the following if any: Navigation: Course Set Up: Logistics: Boat Maintenance & repair: 4. Have you ever been witness to or responsible for a boating accident where another person sustained bodily injury yes no If yes please explain your role in the incident. 2 III. TEACHING EXPERIENCE: l. What experience have you had in teaching sailing Type of boat # of years Where Level 2. What other teaching experience outside of sailing have you had Subject # of years Where Level IV. PRESENT CERTIFICATIONS: Not prerequisites however if you plan to work with the public teaching sailing CPR/First Aid certification is required. Sailing: Issued by: Expiration date: / / Swimming: Issued by: Expiration date: / / Lifesaving: Issued by: Expiration date: / / CPR/First Aid : Issued by: Expiration date: / / FCC Radio Operator s License: Type Expiration date: / / Teaching credentials: Type: Expiration date: / / Other: Type: Expiration date: / / 3 V. REASONS FOR INTEREST IN BEING A SAILING INSTRUCTOR: Please provide a brief statement about why you would be interested in being a youth sailing instructor for the summer or 2011. Please provide the dates and times from June 1 2011 through August 31 2011 that you would be available to teach. VI. REFERENCES: Please provide a list of 3 persons t

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