ST JOSEPH ROCKET FOOTBALL

Coaching Application

(All information provided is Confidential)

Personal Information (please print all information)

Full Name: ______________________________________________________________________________________________________

                                                      Last                                                First                                               Middle

Address: ___________________________________________________City:_________________St:_______  Zip:_______

Home Phone: _____________________  Work Phone: _____________________ Cell Phone: ________________________

Email: _____________________________________________________________________________________________________

Employer: _______________________________________ Occupation: __________________________________________

Football Coaching Information:

Circle Division(s) in which you wish to coach this year (estimate division you expect your child to be in):

Flag                          Minor                       Major

Would you accept an assistant position if not selected or if a head coaching position is not available? ___________________

Have you ever coached or been involved with a youth football league in the past?  Please indicate years and level.

_________________________________________________________________________________________________________________________________

Do you have experience coaching any other youth sports?  Please indicate sport, years and level. 

________________________________________________________________________________________________________________________________

Do you have any coaching certifications or training?

____________________________________________________________________

Have you taken First Aid, CPR or AED Training?

_____________________________________________________________________

Will you have a child participating in the program?

________________________________________________________________________________________________________________________________

Please list one personal reference with phone number for character verification? 

________________________________________________________________________________________________________________________________

Please provide any additional information that you wish us to consider.

________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________

I understand that:

             A.  There is a selection process for all coaches and this may include an interview.

             B.  If selected, I must complete a background check and all required training.

             C.  If selected, I will sign a coaching contract and code of ethics.

             C.  In signing this application, I affirm that the information I have given is true and correct.

Signature of Applicant: _______________________________________________________ Date: ____________________