COACHING and FOOTBALL TEAM MOMĀ 

2017 APPLICATIONĀ 

APPLICATION FOR:

GRADE:

First Name

Last Name

Address

City

State/Province

Postal/Zip

Home Phone

Work Phone

Mobile Phone

Email

SSN

Driver's License Number

PROOF OF AUTOMOBILE INSURANCE IS REQUIRED TO MEET OHIO STATE MINIMUM REQUIREMENTS. Policy Number:

References( List 3 Non-Related) Reference 1

Reference 2

Reference 3

Employment History - Present Employer

Name of Supervisor

Address

City

State

Postal/zip

Dates of Employment

HAVE YOU EVER BEEN ARRESTED, CHARGED OR CONVICTED OF A CRIME TO INCLUDE BUT NOT LIMITED TO DUI, OTHER ALCOHOL RELATED OFFENSES, MISDEMEANOR OFFENSES AND ALL FELONIES? IF YES, EXPLAIN:

HAVE YOU EVER BEEN INVOLVED IN AN INCIDENT INVOLVING CHILD ABUSE OR NEGLECT? IF YES, EXPLAIN:

HAVE YOU EVER HAD OR DO YOU HAVE A PROBLEM WITH DRUGS AND/OR ALCOHOL? IF YES, EXPLAIN:

REASON FOR WANTING TO VOLUNTEER:

WHAT INTERESTS YOU ABOUT THIS POSITION?:

WHAT EXPERIENCE DO YOU HAVE WORKING WITH CHILDREN?:

LIST THE SPORTS YOU HAVE COACHED:

LIST ANY FORMAL TRAINING YOU HAVE RECEIVED IN COACHING:

LIST ANY FORMAL TRAINING YOU HAVE RECEIVED IN FIRST AID:

LIST ANY FORMAL TRAINING YOU HAVE RECEIVED IN TEACHING CHILDREN OR PARENTING:

WHAT ARE YOUR PLANS FOR AN EDUCATIONAL AND RECREATIONAL YEAR FOR THE CHILDREN OF WCRA?:

TODAY'S DATE:

SIGNATURE / SUBMISSION:

AS AN APPLICANT, I REALIZE THAT A BACKGROUND CHECK WILL BE CONDUCTED ON ALL COACHES AND ADVISORS AND THEREBY WAIVE ANY AND ALL PRIVACY RIGHTS PURSUANT TO OHIO AND FEDERAL STATUTES. BY SIGNING THIS APPLICATION, I AGREE TO ALLOW THE WCRA TO CONDUCT THIS CHECK. I ALSO AGREE THAT IN THE EVENT OF AN UNFAVORABLE FINDING, I WILL NOT BE CONSIDERED FOR THE POSITION APPLYING FOR. BY APPLYING FOR SAID POSITION I HEREBY UNDERSTAND THAT THERE EXIST NO APPEAL RIGHTS IF I AM NOT SELECTED.

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