Coaching Application- part I

Full Name: *

Contact Phone Number: *

Street Address: *

Email Address: *

What sport are you interested in coaching?: *

What age group are you interested in coaching?: *

Will your child be on the team?: *

Yes

Child's name:

Practice Choice: *

Day(s) of the week and time (after 5:00pm)

Volunteer Experience- New Coaches Only:

Please note approzimate dates, types and places of experience.

Have you ever been charged with a crime that resulted in plea of guilty, no contest, deferred judgment or deferred prosecution?: *

Yes

Have you ever been convicted of any law violation (except minor traffic violations)?: *

Yes

If Yes for the above questions, please list (A) date of offense, (B) charge, (C) jurisdiction, (D) court name, (E) disposition:

Have you ever been involved in an incident involving child/elder abuse or neglect?: *

Yes

Release Authorization: *

Please type your full name if you agree to the following statements.

In connection with my application for volunteering, I understand and authorize the City of Evans and Southeastern Secuirty Consultants to obtain information regarding myself. This includes the following:

Employment records/Employers references
Criminal background records/information
Criminal background check/fingerprints
Driver's license check
Automobile insurance check
Training/experience
Personal references
Addresses

I, the undersigned, authorize this information to be obtained either in writing or via telephone in connection eith my volunteer application. Any person, firm, or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be helpd in confidence i accordance with the organization's guidelines.

Coaching Application- part I

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