RiderCoach Hiring and Candidate Application
Please complete the following information: (type or print)
Are you now, or have you ever been an MSF RiderCoach or Instructor? ____ RC # ______Expiration date: ______
PERSONAL
Full Name ______
Address______
______
Employer______Occupation ______
Home Phone (______) ______- ______Cell Phone (______) ______- ______
Work Phone (______) ______- ______Fax (______) ______- ______
Email: ______
Are you 21 years of age or older? ❏ Yes ❏ No ❏ Male ❏ Female
EDUCATION
High School or GED ❏ Yes ❏ No
College/University Graduate ❏ Yes ❏ No If Yes, Major______Highest degree earned______
List other educational institutions you attended or any specialized training you have received. Be sure to identify any certificates or advanced degrees. Use additional paper if necessary.
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______
MILITARY If active duty, complete the following:
❏ Airforce ❏ Army ❏ Marines ❏ Navy ❏ Coast Guard ❏ Duty Title______
Rank ______Organization & Office Symbol ______
How long stationed here? ______
DSN Number______Extension ______
Commercial Number ______Extension ______
MOTORCYCLE EXPERIENCE
Do you currently ride a motorcycle on a regular basis? ❏ Yes ❏ No - Approximate # of miles ridden per year ______
Motorcycle Operator’s License # ______State ______
How many years have you had a motorcycle license or endorsement? ______
Have you ever had your license revoked or suspended? ❏ Yes ❏ No
If yes, When? ______Where? ______
Why? ______
______
How many years have you been a motorcyclist? ______
How many motorcycles do you own? ______
What type(s) of motorcycle do you own? ______
What type of riding do you currently do? ❏ Dirt ❏Touring ❏Commuting ❏ Other / specify ______
Have you ever been involved in motorcycle racing? ❏ Yes ❏ No If yes, what type: ❏ Dirt Track ❏ Enduro ❏ Motocross
❏ Road ❏ Observed Trials
Are you familiar with the Motorcycle Safety Foundation:
Basic RiderCourse (BRC)? ❏ Yes ❏ No
Motorcycle RiderCourse (MRC:RSS)? ❏ Yes ❏ No
Experienced RiderCourse (ERC)? ❏ Yes ❏ No
Advanced RiderCourse/Sportbike Techniques (ARC/ST)? ❏ Yes ❏ No
Have you attended/completed any of the following motorcycle safety courses?
Basic RiderCourse (BRC) ❏ Yes ❏ No - If yes, when/where?______
Motorcycle RiderCourse (MRC:RSS) ❏ Yes ❏ No - If yes, when/where?______
Experienced RiderCourse (ERC, BRC2) ❏ Yes ❏ No - If yes, when/where?______
Advanced RiderCourse/Sportbike Techniques (ARC/ST) ❏ Yes ❏ No - If yes, when/where?______
Other ______
Describe in detail why you want to become an MSF-certified RiderCourse RiderCoach. Use additional paper if necessary.
(This is a screening process. What sets you apart?)
______
______
Give a brief description of any other teaching experience.______
______
______
CHARACTER
Have you ever been convicted of (including a plea of guilty or no contest) a felony, or serious misdemeanor, other than a minor traffic violation? ❏ Yes ❏ No
Are you now undergoing, or have you ever undergone treatment during the last five (5) years for the use of drugs, narcotics or excessive alcohol use? ❏ Yes ❏ No
Do you have any medical condition that requires accommodation or that would otherwise impair your ability to safely perform the duties of a RiderCoach? ❏ Yes ❏ No
If yes to any of the above, please explain fully: ______
______
______
SPONSORSHIP
Are you being sponsored for this course? ❏ Yes ❏ No
If yes, by whom? ______
What assistance will your sponsor provide? ______
Where will you teach rider training after graduation? Have you talked to them? ______
ACKNOWLEDGEMENTS
This application does not guarantee a position in a RiderCoach Preparation Course nor does it guarantee that the Motorcycle Safety Foundation (MSF) will issue the applicant a RiderCoach Certification. If the applicant is offered a position in a RiderCoach Preparation Course and the applicant successfully completes the RiderCoach Preparation Course, the MSF may issue a RiderCoach Certification to the applicant. A RiderCoach Certification will only be issued upon execution of a RiderCoach Certification Agreement between the applicant and the MSF. This application shall become an integral part of any RiderCoach Certification Agreement that may be executed between the applicant and the MSF. Unless and until the MSF issues a RiderCoach Certification to the applicant, the applicant is not an authorized, certified RiderCoach and may not make any representations or perform any acts as such.
I certify that I have read this RiderCourse RiderCoach Preparation Candidate Application in its entirety, and the information contained herein is true and correct and that I have not omitted any relevant information. I understand and agree that falsification of any information provided herein, or the omission of any relevant information, will result in immediate revocation of my MSF RiderCoach Certification.
Signature______Date ______
Requirements to become a North Carolina RiderCoach include:
a. Licensed, experienced motorcycle operator with a minimum of 3 years licensed riding experience.
b. High School diploma or equivalent.
c. 21 years of age minimum.
d. Driving record with no more than 3 moving violations, no alcohol related traffic violations, and no driver’s license
suspension, revocation, or denial within the three years preceding the date of application to become a coach.
e. Graduate of a Motorcycle Safety Foundation Course (BRC, ERC or BRC2).
f. Have a recommendation from a current RiderCoach.
g. Certified in CPR.
h. You will be expected to be a role model for North Carolina motorcyclists, and as such, will be expected to wear the
proper gear, to include a DOT helmet, eye protection, sturdy over the ankle footwear, long pants of durable
material, long sleeved shirt or jacket and full fingered gloves; ANYTIME that you ride a motorcycle.
Do you meet these above requirements? ❏ Yes ❏ No If not, please explain: _______
______
______
Teaching a motorcycle safety course is physically demanding. It requires long hours, walking several miles in the course of a day, bending and stooping to place cones, and sometimes the need to push inoperable motorcycles for distances up to ¼ mile. Hot and cold weather conditions can add to the strenuous conditions you will encounter while teaching the course.
Do you feel you are physically capable of performing this job? ❏ Yes ❏ No
To maintain certification, RiderCoaches are required to teach a minimum of three classes a year in the N.C. Community College System, and attend an annual update training session.
You will also be required to follow the MSF RiderCoach Rules of Professional Conduct.
You will also need to request, a copy of your driving record. In North Carolina, this can be done through the NC DMV website. Dependent upon the state of residence and situation, it may take several weeks to obtain the record. Don’t delay the submission of your RiderCoach application while you wait for the driving record. You can send the driving record at a later date or bring it to the first night of your class. You will be required to submit a driving record every two years coinciding with your MSF recertification.
Do you agree to these conditions? ❏ Yes ❏ No
If you are not currently certified in CPR, you must obtain this certification prior to teaching your first class.
I certify that I have read and understand the requirements to become a RiderCoach in North Carolina and that the information contained herein is true and correct and that I have not omitted any relevant information. I understand and agree that falsification of any information provided herein, or the omission of any relevant information, will result in immediate revocation of my North Carolina RiderCoach Certification.
Signature______Date ______
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