STATE TEAM COACH EXPRESSION OF INTEREST
Please fill out the form to complete your expression of interest.
Personal Details
*
Prefix
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Postal
E-mail
*
name@example.com
Mobile Number
*
Phone Number
Work Number
What Water Polo Club are you a member of, or associated with:
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What experience do you have as a high-performance coach?
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Are you available to coach the relevant age state squad from June until the National State Championships scheduled in Canberra for 28 September (Departure date) to the 4th October?
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Yes
No
Please provide any relevant information
Governance
Governance Requirements (Please provide copy or evidence of completion).
*
Working with Children Card
Sport Intergrity Australia Requirements as stipulated by WPA for NSC
Anti-doping (former Level 1)
Antidoping Annual Update 2025
Coaches Course
Child Safeguarding in Sport Introduction
Governance Recommended (Please provide copy or evidence of completion).
Whereabouts Course
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Qualifications
Please provide brief details of any formal qualifications you may have.
*
Statement of Interest
Please outline why you are applying, the relevant skills, knowledge and experience you will bring to the role and how you will approach your position as a State Team Coach. Please include the team you would like to coach: 15&U Boys, 15&U Girls, 17&U Boys, 17&U Girls. Please attach any supporting documents.
*
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Please provide details of two professional referees
Please provide dtails of two professional referees.
Name of first referee
*
First Name
Last Name
Organisation
*
Position
*
Phone Number
*
Please enter a valid phone number.
Name of second referee
*
First Name
Last Name
Organisation
*
Position
*
Phone Number
*
Please enter a valid phone number.
Please sign and date
The information set out in this form is true and correct to the best of my knowledge. If successful, I will adhere to all WPA and WPWA policies and requirements under the National Integrity Framework.
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Date
-
Month
-
Day
Year
Date
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