CENTRALPOINTSCHOOL DISTRICT 6

VOLUNTEERMIDDLE SCHOOL

ATHLETIC COACHING APPLICATION Application Date: ______

Please complete each section fully and accurately. Incomplete applications will not be considered. Please Print

Full Name
Physical Address
City
Mailing Address (if different from above)
City
Home Phone / Work Phone / Mobile Phone
Email
Emergency Contact / Contact / Relationship

Are you 18 years or older: [ ] Yes [ ] No

Coaching position your are applying for: ______

Grade/Sport School (if you have a specific school you want to coach at)

Have you coached for District 6 before [ ] Yes [ ] No

If yes, which school, sport, and age group have you coached? ______

Previous Experience:

List any specific skills, experience, or relevant organizational affiliations:

______

______

______

List previous coaching positions:

1.

______

Position Reference Contact Phone number

2.

______

Position Reference Contact Phone number

3.

______

Position Reference Contact Phone number

Prior Events: Please check YES or NO for each question

Have you ever been dismissed from a coaching position before? [ ] No [ ] Yes If yes, explain

______

______

Have you ever been convicted of any violation of law, except minor traffic violations? [ ] Yes [ ] No

If yes, please explain______

______

If retained for a coaching position, coaches must be fingerprinted and complete a Criminal History Verification.Failure to disclose this information will result in immediate dismissal or disqualification.

Coaching Certifications

Coaches must hold valid and current First Aid certification

First Aid Certification: Issued through (Agency) ______

Expires: ______(Attach copies of back and front of cards or certificates)

Coaches must complete an on-line exam through the National Federation of StateHigh School Associations (NFHS)

Coaches Agreement

I agree that if I am selected to serve as a Head Coach of a team: (Please check each statement)

__I will attend all coach meetings or send a representative.

__I will complete the NFHS on-line exam prior to working with athletes.

__I will read, understand and abide by all SOMSAC league rules, athletic code of conduct and activities

handbook.

__I will be responsible for inventory and the return of all equipment and uniforms.

__I will be responsible for my team’s and coach’s conduct on the field/court.

__I will be responsible for my teams’ parents conduct during a game.

__I will set a good example for the players and parents on my team.

__I will be responsible for ensuring the safety and accountability of all players on my team until they are

released to a guardian or administration.

Agreement and Acknowledgement:

I hereby certify, by my original signature below, that the information I have provided is accurate and true to the best of my knowledge.I understand this is a preliminary application and not a contract to employ me. If selected as a volunteer coach, I understand that all positions are for one year.

Furthermore, I authorize CentralPointSchool District 6 to conduct a Criminal History Verification prior to my volunteering as a middle school coach. I understand that providing false statements or falsification of information will result in disqualification of employment.

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Applicant’s Signature Date

1