Hollis Brookline Jr Cavaliers Football and Cheer

BOARD/ COACH APPLICATION

POSITION APPLYING FOR
Title / Date of Birth
PERSONAL INFORMATION
Full Name
Address
E-Mail
Home Phone Number / Mobile Phone #
EMPLOYER INFORMATION
Employer’s Name / Work Phone #
Employer’s Address
Work Schedule – Days & Hours
Previous Employer’s Name / Work Phone #
Previous Employer’s Address
REFERENCES
Name / Phone Number
Address / Relationship to You
Name / Phone Number
Address / Relationship to You
BACKGROUND INFORMATION
Have you ever been convicted of a crime? – Yes or No / If yes, please explain?
Have you ever been convicted of a traffic offense? – Yes or No / If yes, please explain?
Have you ever been involved in a serious traffic accident – Yes or No / If yes, please explain?
Do you have auto insurance & do you consent to providing a copy of your policy to include limits of liability – Yes or No
Do you agree that your insurance will continue as primary party when participating in a HB Jr Cav activity? – Yes or No
Do you have daily internet access? – Yes or No
Do you have access to and ability to produce MS Word documents and MS Excel spreadsheets? – Yes or No
HB & VOLUNTEER EXPERIENCE
Do you have experience working with youth organizations? / # of Years / Organizations
Do you have a child in program? / Team child or children play for?
Community – Are you willing & able to increase the community spirit across the entire Jr Cavs football & cheer programs?
Commitment – Are you willing & able to elevate the commitment level of other board members, players, coaches & parents in the football & cheer program?
Competitiveness – Are you willing & able to elevate the competitiveness of the football & cheer programs of HB?
Consistency – Are you willing & able to align with a consistent approach and philosophy across the entire board?
NARRATIVE
Why are you interested in being a board member for the HB Jr Cavs?
What makes you a positive role model for the youth of the HB Jr Cavs?
How would the board members, players and parents of the last youth organization you worked with describe you?
How would you go about improving the HB program?
AUTHORIZATION & LIABILITY
Authorization / I authorize in Officers of the HB Jr Cavs on behalf of the said organization to obtain information about me and conduct a background investigation to include a criminal records and/or motor vehicle records check that is pertinent to my participation as a Community Center Volunteer.
Signature / Date
Release of Liability / In consideration for my participation in activities of the HB Jr Cavs, I hereby waive, release and discharge all claims for death, personal injury or property damage which I may have or which may hereafter occur to me as a result in said activity or any activity incident thereto. This release discharges in advance the city of Hollis-Brookline; its officers, agents, servants and employees from any and all liability. I understand that some recreational activities involve an element of risk or danger of accidents, and knowing those risks, I hereby assume those risks. This waiver, release and assumption of risk are to be binding on my heirs and assigns. I also give my permission for any necessary emergency medical treatment.
Signature / Date
APPLICATION INFORMATION
Mail Completed Application
To The Following Address / HB Jr Cavs
PO Box 581
Hollis, New Hampshire 03049 / Email