North Haven Soccer Club

Coaching Application

Applicant Background and Coaching Experience

Applicant’s Name: ______

NOTE: This must match the name that you will provide when completing the CJSA Background Check.

Home Phone Number: ______Cell Phone Number: ______

Home Address: ______Town: ______Zip Code: ______

E-mail: ______Birth Date: ______

Soccer Playing Experience: (Circle Yes or No for each category)

In High School: Yes No In College: Yes No Semi-Pro/Pro: Yes No

Please list these teams here: ______

______

Soccer Coaching Experience:

How many years have you coached soccer? ______

Please list the teams that you have coached (provide team name, town, age, and gender):

______

______

Which gender/age group do you prefer to coach?

Choice # 1: Gender: ______Age: ______

Choice # 2: Gender: ______Age: ______

Choice # 3: Gender: ______Age: ______

List any coaching certificates/licenses that you currently hold: ______

______

List any other relevant licenses (Refereeing, First-Aid/CPR, Strength/Conditioning, etc.):

______

Non-Soccer Coaching Experience:

Have you coached any other sports’ teams? If so, please list teams below:

______

Relevant Information

1) Which position would you like to apply for (please circle below)?

Volunteer Position (which includes any Recreational/Rec Team)

Paid Position (which includes: Competitive, Step-Up, or Developmental Team)

2) If hired, would you be willing to co-coach a team? Yes No

PLEASE NOTE:

By circling Yes above, you would be agreeing to divide the payment if hired as a paid coach.

3) If you are applying for a paid position, but not hired, would you consider coaching a non-paid Recreational Team? Yes No

4) Is there any other relevant information that you would like to share with the North Haven Soccer Club? (For example: current occupation, related experience, educational experience, other training, etc.)?______

______

5) What do you consider to be your coaching philosophy? ______

6) Why are you interested in coaching for the North Haven Soccer Club?

______

NOTE: The CJSA (Conn. Junior Soccer Association) requires all volunteer and paid employees to complete a criminal background check. The cost of your background check will be paid by CJSA. This check will be made from public record sources and you will have an opportunity to challenge any adverse information disclosed by the check.

The North Haven Soccer Club and Directors of Coaching are constantly working to raise the level of soccer knowledge and awareness within the town. We are requiring that all VOLUNTEER COACHES attend at least two coaching modules per year. We are requiring that all PAID COACHES attend at least four coaching modules per year. I understand that if I am selected to coach a team, I will be obligated to attend these mandatory modules and could be released if I fail to do so.

Signature of Coach: Date: