ODU Sport Club New Coaches Application
Street Address Line 2
State / Province
Postal / Zip Code
University ID Number or Social Security Number
Date of Birth
Drivers License Number, State & Expiration Date
Primary Phone Number
Alternative Phone Number
Location: City, State
High School Graduate
Location: City, State
Highest Degree Received
Please detail your experience playing this sport, to include the number of years and level of play
Please detail your experience coaching this sport, to include the number of years, level, and certifications.
Please explain your short term (first year) AND long term (beyond the first year) goals for the club.
Old Dominion University may obtain information regarding your criminal history, social security verification, and motor vehicle records “driving records”. Please be advised that the nature and scope of this notice and authorization is all-encompassing to include National Background Investigations, Inc, PO Box 966, Stevensville, MD 21666, 800-798-0079 or another outside organization. By signing this notice and authorization you are allowing OLD DOMINION UNIVERSITY to obtain from any outside organization all manners of investigative reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer reports.
Acknowledgement & Authorization
By submitting this form, I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand the nature of this background investigation. I hereby authorize the obtaining of “investigative consumer reports” by Old Dominion University at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance to furnish any and all background information requested by National Background Investigation, Inc, PO Box 966, Stevensville, MD 21666, 800-798-0079 another outside organization acting on behalf of Old Dominion University and/or Old Dominion University itself. I agree that facsimile (fax), electronic or photographic copy of this Authorization shall be as valid as the original. By my initials below, I authorize NBI to provide Old Dominion University with background investigative reports.
By my initials below, I authorize NBI to provide Old Dominion University with background investigative reports.
Initial to agree
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