Coaches Application

Updated Thursday January 4, 2018 by JG.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SGSA COACHES APPLICATION 2018

 

 

FULL NAME (FIRST, MIDDLE, LAST): _____________________________________

PREVIOUS NAME, MAIDEN, OR NICKNAME:_______________________________

DATE OF NAME CHANGE OR MARRIGE DATE: _____/______/______

MAILING ADDRESS:___________________________________________________

HOME PHONE :(_________)__________________________            

CELL PHONE: (_________)___________________________  

DATE OF BIRTH:  ______/______/_________           GENDER: _________________

SOCIAL SECURITY NUMBER: ________________________________

DRIVER’S LICENSE NUMBER: _________________________    STATE: ________

EMAIL ADDRESS: ____________________________________________________

Have you ever been convicted of a crime?   YES / NO (circle one)  

If YES, please explain __________________________________________________

_____________________________________________________________________

Are you Rutgers Safety Certified or Babe Ruth Certified?     YES / NO

All persons completing this form must read and sign below:  I consent to have the Stafford Girls Softball Association use this information above to conduct a background check to determine whether an allegation of child abuse or a criminal allegation has been substantiated against me.  I certify that all information I have given on this form is accurate and complete to the best of my knowledge.

Signature: _______________________________ Date: ___________________________

Note: Pursuant to federal Privacy Act of 1974 (P.L. 93-579), the disclosure of your Social Security number is voluntary.  Your Social Security number, race, date of birth, and gender will only be used for the purpose of conducting a Child Abuse Record Information background check as authorized by the State Child Care Center Licensing Law (N.J.S.A. 30:5B-1 to 15)

2018 Coaching Application.pdf