☐ Coach ☐ Umpire
1
2
3
4 / First name
Last name or family name
Date of birth
Gender
Form of transport
/ 5
6
7 / Mobile phone number
Email address
Residential address (in Melbourne)
Suburb
Postcode State
8 / Availability
Please indicate the hours that you are available during the week. School sessions range between 7-6pm on weekdays and Saturday matches 6am-1pm.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
/ 9
10 / Please indicate the date that you are available until, ie. leaving Melbourne. Also please note any date(s) that you are unavailable for during the year, ie. uni exam periods, uni placement dates, holiday trips, etc
Date available from Date available until
(a) Unavailability
Date from Date until (optional)
(b) Unavailability
Date from Date until (optional)
(c) Unavailability
Date from Date until (optional)
/ 11 / Please indicate the regions that you are available to work
☐ North ☐ Outer East
☐ Inner ☐ East
☐ West ☐ South East
12 / Education
University Campus location
Course Name (current or completed)
Current year Total years of course
Date started Date finished
/ 13 / Work experience
Employment position (current or last previous)
Company
Work type
Date started Date finished
14 / Playing experience
Please indicate your top 3 sport(s), year started and finished, and highest level played.
Sport Start Finish Club/school, age group, comp level, comp won, etc.
15 / Coach experience
Please indicate your top 3 sport(s), year started and finished, and highest level(s) coached.
Sport Start Finish Club/school, age group, comp level, comp won, etc.
16 / Coach accreditation
Sport Date completed Accreditation level and description
17 / Umpire/referee experience
Please indicate your top 3 sport(s), year started and finished, and highest level(s) umpired.
Sport Start Finish Club/school, age group, comp level, tournament etc.
18 / Umpire accreditation
Sport Date completed Accreditation level and description
19 / Working with Children Check (WWC)
Do you hold a current Victorian Working with Children Check qualification? Yes or No
WWC Check number
If you’ve applied for a WWC Check and is currently being processed, please include your Application No above.
WWC Check card type
/ Application status
Date expired (valid 5 years)
20 / First Aid qualification
Do you hold a current First Aid qualification? Yes or No
Date expired (valid 3 years)
/ Application status
Course date booked
21 / CPR qualification
Do you hold a current CPR qualification? Yes or No
Date expired (valid 1 year)
/ Application status
Course date booked
22 / Anaphylaxis qualification
Do you hold a current Anaphylaxis qualification? Yes/No
Date expired (valid 3 years)
/ Application status
Course date booked
23 / References
Please provide contact details of one (or more) professional references relating to your sport coach experience, umpire or playing experience. (No family members or friends will be accepted).
If you do not have any contacts who could be used for a reference check, please provide a written reference.
Reference full name (1)
Contact number
Email address
Company
Position
/ Reference full name (2)
Contact number
Email address
Company
Position
Application questions
The Melbourne Sports Institute would like to know some extra information to help them with your application.
1) Are you eligible to work in Australia
☐
☐
☐
☐
2) In one sentence, describe why you are passionate about sport?
☐
3) In one sentence, describe what you aim to fulfil in coaching young people?
(Please answer only if you are applying for coach positions)
☐
4) How many hours a week do you expect to work as a coach for the Melbourne Sports Institute?
(Please mark one box only)
☐
☐
☐
☐
☐
5) How many hours a week do you expect to work as an umpire for the Melbourne Sports Institute?
(Please mark one box only)
☐
☐
☐
☐
☐
6) Do you expect this job to be your primary source of income
☐
☐
☐
7) Where did you hear about us?
☐