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OKANAGAN MISSION SECONDARY COACH APPLICATION FORM
okm_coach_application.pdf
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23 kb
File Type:
pdf
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Okanagan Mission secondary coach application form
(for internal school use - this form should be completed for EVERY Community Coach)
*
Indicates required field
Date
*
Name
*
First
Last
Date of Birth
*
Address
*
Phone Number (H)
*
Phone Number (B)
*
Cell Phone Number
*
Email
*
1) NCCP Coaching Qualifications
NCCP #
*
Certification Level: Theory
*
Date Completed
*
Certification Level: Technical
*
Date Completed
*
2) Previous Coaching Experience:
Previous Coaching: School
*
Previous Coaching: Community
*
3) Coaching Philosophy:
*
4) Which sport(s) would you like to coach, and at what level?
*
5) Personal History:
5a) Are you currently under probation or suspension from coaching duties within any school or community sport program?
*
Yes
No
5b) Have you ever been convicted of a criminal offence?
*
Yes
No
5c) Do you have criminal charges pending?
*
Yes
No
If YES for 5 a), b) or c), please provide details
*
6) Medical
6a) Do you know of any medical condition that may hamper or affect your ability to carry out coaching activities?
*
Yes
No
6b) If yes for 6a), please provide details:
*
7) References
Please provide the names and contact information for three (3) references:
Please provide the names, Relationship, and phone number for three (3) COACHING references:
*
Please provide the names, Relationship, and phone number for three (3) PERSONAL references:
*
Permission to conduct a Criminal Record Check: Print
THIS FORM,
sign and return to school.
Submit