QUEEN OF ANGELS COACHING APPLICATION

Name _________________________________________________________

Address _______________________________________________________

City, State, Zip __________________________________________________

Sport(s) interested in coaching _______________________________________

     1.  Have you ever coached before? Where? When? Who was your supervisor?

    2. a) Do you use illegal drugs?

        b) Have you ever been convicted of a criminal offense?

        c) Has your driver's license ever been suspended or revoked? If yes, please

            explain. Please submit a copy of your driver's license.

         d) Have you ever been legally adjudged to have committed child abuse or sexual

             molestation?

   3. List three references               a. ________________________________

                                                     b. ________________________________

                                                     c. ________________________________

  4. Are you currently trained in First Aid?

  5. Are you currently trained in CPR?

I understand that the information that I have provided will be verified by contacting the appropriate organizations. I understand adverse information will disqualify me or any misleading information provided will disqualify me.

In signing this application, I have read the information and apply for coaching in the Queen of Angels Athletic Program. I affirm that the information I have given on this application is true and correct.

Signature of Applicant ______________________________ Date__________

Please return to Athletic Department