THESA Coaching Application

Please fill out the following 2-page document if interested in volunteering or working as a coach.

Please Print Clearly:

Date: ___________________ Position Desired: _______________________________________________

Name: _______________________________________ Date of Birth: ______/______/______

Telephone: (H) (____)_______________ (W) (_____)________________FAX (____)________________

Cell Phone: _______________________     Email: __________________________

Residence Address: ____________________________________________________________

City______________________________ State________ Zip _________

How long at above address? ______________ Social Security No. ________________________

Driver’s License Number: ____________________ Driver’s License Classification: A B C M

List last two previous residential addresses:

Address _____________________________________ City _______________ State _______

Zip __________ How long? _______________

Address _____________________________________ City _______________ State _______

Zip __________ How long? _______________

EMPLOYMENT HISTORY

1. What is your occupation? (Be specific) ___________________________________________

Place of employment ________________________________________________________

Business Address __________________________ City ___________ State ____ Zip ______

Previous Employer __________________________________Phone (_____) ____________

Business Address __________________________ City ___________ State ____ Zip ______

How long? ___________________

Previous Employer __________________________________Phone (_____) ____________

Business Address __________________________ City ___________ State ____ Zip ______

How long? ___________________

PERSONAL INFORMATION

2. What is your marital status? ( ) Married ( ) Single ( ) Divorced

3. How many children do you have? _____ sons _____ daughters

4. What high school did you attend? ___________________________________City ________________

State _______

For Questions 5 – 10, attach additional pages if necessary.

5. Describe any formal/informal training you may have had as a coach or volunteer? (Coaching Clinic,

courses, P.E. Degree, etc.)

______________________________________________________________________________________

______________________________________________________________________________________

6. Have you ever been arrested or convicted of any criminal offense? ( ) Yes ( ) No

Please exclude the following situations:

a) minor traffic violation for which the fine was $200 or less

b) any offense which was finally settled in a juvenile court or under a welfare youth offender law.

If "YES," please explain (attach additional page if necessary): _______________________________________________________________

__________________________________________________________________________________

7. Have you ever been asked to leave, refused admittance to, or suspended from any sports organization?

( ) Yes ( ) No If so, which one and why? _________________________________________________

__________________________________________________________________________________

8. What do you hope to gain from volunteering?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

9. What other organizations have you volunteered with (if any)?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

REFERENCES

� If your application was approved last year, you DO NOT need references.

Please list the names, occupations, and telephone numbers of three people (other than relatives) who know

you sufficiently well to provide us a reference. References will be contacted. If you are acquainted with

men already involved in THESA, name them:

Name                                     Occupation                            Work #                             Home #

______________________ ________________________(____)______________ (____)______________

______________________ ________________________ (____)______________(____)______________

______________________ ________________________ (____)______________ (____)______________

� Do you agree to comply with and abide by all the rules, regulations, and rulings of the

organization and its officials? ( ) Yes ( ) No

� Do you understand that any action, either physical or verbal, that is deemed by the Board of

Trustees to be detrimental to THESA, or baseball in general, will cause your immediate and

indefinite suspension? ( ) Yes ( ) No

� I hereby affirm that my answers to the foregoing questions are true and correct and that I have not

knowingly withheld any fact or circumstance that would, if disclosed, affect my application

unfavorably. I understand that any false information submitted in this application may result in my

discharge.

� I hereby give my permission for the THESA to obtain information relating to my criminal history

record. I understand that this information will be used to determine my eligibility for my volunteer

position with this organization. I also understand that as long as I remain a volunteer here, they

may repeat this criminal history records check at any time.

____________________________________________ _________________

SIGNATURE                                                                  DATE