Football Coach Application

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Position Applying for?

Experience

Other Coaching jobs

Cell Number*

Area CodePhone Number

Birth Date

MonthDayYear

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Contact's Phone Number

Area CodePhone Number

Have you ever been convicted of a felony?*

YesNo

Are you willing to participate as a volunteer at fundraisers, carwashes, work at gate, and or work theconcession stand?*

YesNo

Do you have your clearances?*

YesNO

Do you have a valid drivers license?

YesNo

Do you have any allergies or medical issues that need to be known by PHYFCA?

YesNo

Please write a brief explanation of what positive attributes you have that will make you a good asset to PHYFCA coaching staff.

I understand that my volunteer position with PHYFCA is contingent upon my truthful completion review of this form. I authorize and understand that PHYFCA may obtain a criminal history report that is only visible to the PHYFCA board. I understand that I may be immediately discharged for any misrepresentation or material omission on this form. I understand that any pending arrest or closed arrest is not an automatic bar to consideration of my application, but it is the intent of PHYFCA to deny a position to any person who has been convicted of sexual abuse, physical abuse or exploitation of a minor.

* Check this if you read and agree to theprevious statement

I Agree