PMSS Coach Application Form (DATABASE)

1
Full Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Which age groups do you prefer coaching?* This field is required.
Under 6 - Under 7
Under 8 - Under 13
Under 14 - Under 16
Under 17 - Under 19
All of the above
6
What is your current coaching status?* This field is required.
Unemployed
Employed
Student
Other
7
Have you ever been convicted of a criminal offence?* This field is required.
YESNO
8
Have you any prosecutions pending?* This field is required.
YESNO
9
Declaration* This field is required.I confirm that the information provided in this application form is truthful and accurate. I have omitted no facts that could affect my employment. I understand that any false or misleading statements could place any subsequent employment in jeopardy. I understand that any employment entered into is subject to documentary evidence of my right to work in the Republic of South Africa and satisfactory references. I expressly consent to personal data contained within this form being recorded for the purposes of assessing suitability for the post and may form the basis of any subsequent personnel file.
10
Terms and Conditions* This field is required.NOTICE IN TERMS OF THE PROTECTION OF PERSONAL INFORMATION ACT (“POPIA”) The Applicant and their parent or legal guardian, by voluntarily submitting their Personal Information (as defined under the Protection of Personal Information Act (“POPIA”)), gives their consent to Pitso Mosimane Soccer Schools and its duly authorised agent, MT Sports Marketing and Management, to collect, process, use and store the Personal Information so submitted for all purposes relating to or arising out of their application to participate in Pitso Mosimane Schools Soccer. Pitso Mosimane Soccer Schools and MT Sports Marketing and Management undertakes to process the Personal Information in relation to the applicant and their parent or legal guardian, voluntarily submitted by them, only in accordance with the conditions of lawful processing as set out in POPIA and only to the extent that is necessary for it to discharge its obligations and perform its functions in eliciting, accepting, processing and managing applications and the continued enrolment of the applicant with and participation in Pitso Mosimane Soccer Schools, within the framework and as required by South African law.
11
Upload your SAFA D License* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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12
Upload your CV* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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