Coaches Application
UpdatedWednesday November 17, 2021 bySK.SGSA COACHES APPLICATION
FULL NAME (FIRST, MIDDLE, LAST): ____________________________________________________________
PREVIOUS NAME, MAIDEN, OR NICKNAME:_____________________________________________________
DATE OF NAME CHANGE OR MARRIGE DATE: _____/______/______
MAILING ADDRESS:__________________________________________________________________________
HOME PHONE :(_________)__________________________
CELL PHONE: (_________)___________________________
DATE OF BIRTH: ______/______/_________ GENDER: ___________________________________
SOCIAL SECURITY NUMBER: ________________________________
DRIVER’S LICENSE NUMBER: ______________________________________ STATE: __________________
EMAIL ADDRESS: ____________________________________________________________________________
Have you ever been convicted of a crime? YES / NO (circle one)
If YES, please explain ____________________________________________________________________________
Are you Rutgers Safety Certified or Babe Ruth Certified? YES / NO
** Please provide a copy of your certification to the board
Did you coach softball in SGSA last season? YES / NO
The team Sponsor & Division you coached for last season________________________________
Shirt size: Small Medium Large X-Large XX-Large
All persons completing this form must read and sign below: I consent to have the Stafford Girls Softball Association use this information above to conduct a background check to determine whether an allegation of child abuse or a criminal allegation has been substantiated against me. I certify that all information I have given on this form is accurate and complete to the best of my knowledge.
Signature: ________________________________________________ Date: _______________________________
Note: Pursuant to federal Privacy Act of 1974 (P.L. 93-579), the disclosure of your Social Security number is voluntary. Your Social Security number, race, date of birth, and gender will only be used for the purpose of conducting a Child Abuse Record Information background check as authorized by the State Child Care Center Licensing Law (N.J.S.A. 30:5B-1 to 15)
*A COACHES APPLICATION AND VOLUNTEER APPLICATION MUST BE SUBMITTED TO THE BOARD
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Coaching Application.pdf |