APPLICATION FOR COACHING POSITION FOR

BLUE RIDGE TRIPLETS FOOTBALL/CHEERLEADING

NAME:

HOME PHONE:

WORK PHONE:

STREET ADDRESS:

TOWN:

STATE:

ZIP:

EDUCATION:

COLLEGE:

OTHER EDUCATION:

PRESENT OCCUPATION:

EMPLOYER NAME:

PHONE:

STREET ADDRESS:

TOWN:

STATE:

ZIP:

LIST EXPERIENCE WITH TRIPLETS OR OTHER YOUTH ORGANIZATION:

LIST OTHER TRAINING/EXPERIENCE HELPFUL IN COACHING:

CURRENT MEMBERSHIP HELD IN OTHER ORGANIZATIONS/POSITON HELD:

CHECK PROGRAM PREFERRED:

FOOTBALL:

A-TEAM

CHEERLEADING:

A-TEAM

B-TEAM

B-TEAM

C-TEAM

C-TEAM

REFERENCES:*

NAME:

ADDRESSS:

PHONE:

NAME:

ADDRESS:

PHONE:

NAME:

ADDRESS:

PHONE:

*Give as reference three people who have known you well enough in your work, school, church

or other organization to judge your qualifications as an adult coaching volunteer.

Have you ever been convicted of a crime other than a traffice violation?

Yes:

No:

If yes, please state offense, date and location.**

**A conviction will not necessarily be cause for disqualification.

SIGNITURE:

DATE:

DO NOT WRITE IN SPACE BELOW

APPROVAL:

TRIPLET PRESIDENT:

TRIPLET VICE-PRESIDENT:

ACTION TAKEN:

TEAM POSITION: