Coaching Application Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Cell Phone # *Home Phone #Date of Birth *Which team (grade) are you applying to coach? *-----1st2nd3rd4th5th6thWhich coaching position are you applying for? *Head CoachAssistant CoachName your assistant coaches: *Name your head coach: *Do you have a child participating on this team? *YesNoHave you ever pleaded guilty to, or have you ever been convicted of a criminal violation? *YesNoExcluding minor traffic infractionsIf yes, include all offenses, dates, and location *Date of offense, Nature of Violation, PlaceAre you aware of any information about yourself, which might tend to reflect unfavorably on your reputation, morals, character, or ability as a prospective coach for the Carlisle Peewee Football Program? *YesNoIf yes, please explain: *Would you like to include references? *YesNoReferences are optional. Reference 1 NameFirstLastPhone Reference 2 NameFirstLastPhone Reference 3 NameFirstLastPhoneNext Please answer the following questions to the best of your ability. What is your personal coaching philosophy? *What is your coaching experience? *Explain basic offensive and defensive formations that you would teach: *Do you have any coaching certifications or training? *Are you CPR, First Aid, or Concussion certified? *YesNoIf you are CPR, First Aid, or Concussion certified, when did you have the training? *Other pertinent information that you would like the Carlisle PeeWee Football program to know: * My signature below acknowledges that I hereby certify the facts set forth in this Coaching Application are true and correct to the best of my knowledge. I understand that if I falsify statements on this coaching application, I may not be considered for coaching duties. I hereby authorize the Carlisle PeeWee Football program, or its representative, to conduct an investigation into my background history to verify the above information. I also understand the final selection of the coaching staff is the sole discretion of the Carlisle PeeWee Board. Further, I will abide by all rules, policies, and by-laws of the League and that my actions can be held accountable to any and all of the aforementioned and that I can be suspended, placed on probation, or removed from coaching by the Carlisle PeeWee Board per their rules and by-laws. SignatureClear SignatureSubmit
