RCYSC Coaching Application Form
COACHING APPLICATION
for 2012 - 2013 season
* These fields are required.
PERSONAL INFORMATION
First Name *
Last Name *
Address *
Home Phone *
(format xxx-xxx-xxxx)
Business Phone
(format xxx-xxx-xxxx)
Cell Phone
(format xxx-xxx-xxxx)
Email * (enter only
one, valid email)
Birthdate (YYYY-MM-DD) *
Position applied for *
(ie Head coach, Assistant)
Head Coach
Assistant Coach
Manager
Other
Preferred Age Group
(ie U13)
U
18
17
16
15
14
13
12
11
10
9
8
7
6
5
Level
(ie Gold, Silver)
Gold
Silver
Bronze
Selects/Developmental
House/Red
Team Gender
Male
Female
NATIONAL COACHING CERTIFICATION
(Please indicate soccer related levels achieved)
Community Coach Children
Community Coach Youth
Community Coach Senior
B Prep
B Provincial
B National
A License
COACHING BACKGROUND WITH RCYSC
Year
(most recent first)
Division
Team Name
COACHING BACKGROUND WITH OTHER CLUBS OR SPORTS TEAMS
Year
(most recent first)
Club
Division
Team Name
OTHER CERTIFICATION, TRAINING AND EXPERIENCE
REFERENCES
Please provide the names of at least two people who would be willing to provide references as to your suitability to coach and general character.
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone
OTHER RELEVANT INFORMATION
Applicants must read and agree to abide by the Club Policies and conduct themselves in a professional manner as a member of the Royal City Youth Soccer Club.
Declaration:
I declare that all of the information provided above is complete and accurate in all respects. I have read and agree to comply with the Royal City Youth Soccer Club Policies. Upon acceptance, I will consent to, and promptly apply for, a Criminal Record check, as per RCYSC policy, and agree that I will not be given a team until such time as the check process is complete.
By checking this box you acknowledge that you understand and agree with the above declaration. *
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