Background Check
I. Personal Information
Are You Looking to Coach A New Team or Are You Already With A Team (what team are you with)
Full Name
First Name
Last Name
What Side Of Town Are You Interested In Coaching?
NE, West, East, Horizon
Previous name (If any)
First Name
Last Name
What Age Group would you like to Coach?
5-7
8-10
Both
Wherever Needed Most
11-13
15u
Present Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address (If any)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Birthdate
-
Month
-
Day
Year
Date
Place of birth
Sex
Male
Female
IV. Criminal History
1. Have you been apprehended, charged or convicted for a crime of violation of law?
Yes
No
2. Are you on probation or parole?
Yes
No
If the answer is Yes to any of the questions above, please provide place, date and violation details on the box:
I hereby declare that the information submitted in this application is true and correct to the best of my knowledge. I understand that any false information will result to disqualifying this application. I hereby authorize {Company Name} and its representatives to perform an extensive review of my background based on private and public information I have provided for employment purposes. I also authorized any agencies or background check companies to perform a background check investigation as part of my application.I fully understand that this investigation will generate a report that may include personal information, education background, employment history, character references, birth records and any other records. I therefore release and hold no harm to any representatives who provides this information from any liability.
Signature
Date signed
-
Month
-
Day
Year
Date
SSN (last 4)
Submit
Should be Empty: