2014COACHING APPLICATION

Please fill out this form completely, leaving no blanks. Sign and date where indicated.

**Remember to enclose the Full Criminal History Background check with your completed application**

FULL NAME (FIRST, MIDDLE, LAST) / HOME PHONE
ADDRESS / WORK PHONE
CITY, ST, ZIP / CELL PHONE
EMAIL ADDRESS / DATE OF BIRTH
PLACE OF EMPLOYMENT / OCCUPATION
NYSCA CERTIFICATION # (if applicable)

List 2 References (non-relatives):

Name: ______Relationship: ______Phone: ______

Name: ______Relationship: ______Phone: ______

Which division would you prefer to coach?
_____ RL – 1st and 2nd grade
_____YL – 3rd and 4th grade
_____OL - 5th and 6th grade / What position are you applying for?
(check one)
_____Head Coach
_____Official Assistant Coach
_____Assistant Coach

Do you have a child(ren) participating at this level? [ ] Yes [ ] No

If yes, child(ren)’s name and division:______

Please list your experience playing sports, past and present: ______

______

Please list your football coaching/squad coaching history and with which organization, (if any):______

______

Please list your other coaching experiences, or involvement with youth organizations (if any): ______

______

______

Please list any certificates or special training that you have received that would benefit you as a coach (if any): ______

______

______

Please state your reasons for wanting to coach a team and your philosophy toward youth sports: ______

______

CRIMINAL HISTORY

Have you ever been convicted of a criminal offense, including child abuse/neglect and drug charges? [ ] Yes [ ] No (check one)If yes, please explain: ______

Do you have any criminal charges pending, including child abuse/neglect or drug charges at this time? [ ] Yes [ ] No (check one) If yes, please explain: ______

______

Please explain and list any other names you have used: ______

______

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I certify that all statements made on this application are true and complete. I authorize any individual, company, organization or institution to release any and all information concerning statements made by me on this application, and I do hereby release all parties and individuals connected therewith from all liabilities for any damages whatsoever incurred in furnishing such information. I agree and understand that any deliberate misstatement or omission will cause forfeiture of all eligibility to volunteer with the Greenwood Bantam Football League. I also understand that the information contained in my Criminal History Background Check may be used for the specific purpose of evaluating my fitness for duty. My signature below acknowledges my understanding and agreement with the above.

Signature: ______Date: ______

Mail this completed application to: Greenwood Bantam Football League

P.O. Box 832

Greenwood, IN 46142

RETURNING HEAD COACHES

If you would like to recommend an Official Assistant Coach at this time please note here:

NAME: ______

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(BOARD USE ONLY)

NYSCA Membership dues paid: Date: ______Initials: ______

Criminal Background Check received: Date: ______Initials: ______

Indiana Sex Offender Registry Checked: Date: ______Initials: ______

*All the above information must be received before interview process begins.

Coaching Interview Committee:

Interview scheduled: ______Coaching Committee recommendation: ______

GBFL Board:

Approved/Denied: ______Date: ______Initials: ______

Team Assigned: ______Position Assigned: ______