Fields marked with a red star
(
*
)
must be completed before this form can be processed..
Personal Information
Full Name
*
Address line 1
*
Address line 2
City/County
*
Postcode
*
Contact Number
*
Work Number
Mobile Number
Email Address
*
Date of Birth
Place of Birth
Attach Your Photo
Do you hold a full current licence?
*
Yes
No
and Do you have use of a car ?
*
Yes
No
Have you been convicted of a criminal offence ?
*
Yes
No
(if YES, give details of the date, nature of the offence and penalty. This information will be treated in the strictest confidence)
Do you have any academic qualifications?
*
Yes
No
(if Yes, enter details below)
Which current sporting qualifications do you hold ?
*
Archery
Athletics
Badminton
Basketball
Bowling
Canoeing
Cricket
Dance
Fencing
FitnessTraining
Football
Gymnastics
Hockey
Ice Hockey
Judo
Martial Arts
Netball
Rowing
Rugby
Sailing
Skating
Softball
Squash
Swimming
Table Tennis
Tennis
Trampolining
Volleyball
Water-Skiing
Do you have a current first aid certificate?
*
Yes
No
(if Yes, when does it expire)
Which type of people have you coach within the last 3 years?
under 7's
8 - 11
12 - 16
17 - 24
25 - 35
36 - 50
50+
all female groups
all male groups
disabled groups
Coaching Employment History
(commencing with your most current employment and work backwards)
EMPLOYER ONE
Position
*
Salary
*
From:
To:
Employers Name and Address
Duties in Brief
EMPLOYER TWO
Position
Salary
From:
To:
Employers Name and Address
Duties in Brief
EMPLOYER THREE
Position
Salary
From:
To:
Employers Name and Address
Duties in Brief
EMPLOYER FOUR
Position
Salary
From:
To:
Employers Name and Address
Duties in Brief
Fields marked with a red star
(
*
)
must be completed before this form can be processed.
