Name:
E-Mail Address:

Street Address:
City: State: Zip:

Phone Number: Emergency Phone Number:

PREVIOUS WORK EXPERIENCE (Most to least recent) - Please be sure to detail all Retail Experience.

Company Worked For:
Phone Number:
City/State/Zip:
Position Held: Manager:
Start Date: End Date:
Reason for Leaving:

Company Worked For:
Phone Number:
City/State/Zip:
Position Held: Manager:
Start Date: End Date:
Reason for Leaving:

ACADEMIC/ PROFESSIONAL SCUBA BACKGROUND

Highest Level of Education attained:
Degree Earned:
Name of School:
Year Graduated:

Please list the various makes of SCUBA equipment you are certified to repair and your proficiency level with each:


Are you trained to work on a SCUBA compressor and if so the make(s) and model(s):

What is your highest level of SCUBA certification:
Year originally certified:

Please state your job goals with our company:


Who referred you to our company for employment:

Do you have your own transportation and if so, make and model of vehicle:

Hourly Wage Sought:
Are you available for full or part time work:
When are you available to start work:
If you answered part time above, what days/hours would you be available? Please indicate below:

If you are unable to submit online, please fax this page to us at (949)221-9323.

Product Information Questions? Contact our certified instructors
E-mail our instructors at info@scuba.com

US and Canada call toll free 1.800.347-2822
International callers please dial 001.949.221.9300

Corporate Office: Scuba.com
1752 Langley Avenue, Irvine CA 92614

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Scuba requires professional scuba diving training and certification
Prices subject to change.
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