HARRISON YOUTH SOCCER CLUB TRAVEL SOCCER COACHING APPLICATION APPLICANT S NAME: ADDRESS: If you have lived at the above listed address for less than five years, please list prior address(es) (use additional page if necessary). HOME PHONE: WORK PHONE: TEAM OR GROUP REQUESTED: BOYS or GIRLS (circle one) 1. Work history (last 5 years) Company Position Dates 2. Why do you want to coach the Travel Team? (Be Specific) 1
3. Have you played soccer? Yes Level (i.e. youth, high school, college, club) Dates played and name of school or program played for: 4. What other sports have you played? Level (i.e. Youth, High School, College, Club) Dates played and name of school or program played for: 5. Have you coached soccer? Yes Level (i.e, youth, club) Number of years coached and team location and league coached 6. What other sports have you coached? Level (i.e, youth, club) Number of years coached and team location and league coached 2
7. Have you had any formal training as a coach? Yes If yes, please describe (for example PE degree, coaching licenses, courses, clinics, etc.; attach copies of certificates or licenses.) 8. Describe any experience or training that would help you coach (for example, teaching, working with youths, etc.) 9. Please rate your knowledge of the following topics with regard to soccer by circling the appropriate number. 1 = You know very little about it 2 = You have reasonably good knowledge about it 3 = You know a great deal about it 1 2 3 Skills and strategies of the sport 1 2 3 Developing sportsmanship 1 2 3 Rules of the sport 1 2 3 Communication skills 1 2 3 Warm-up and physical conditioning 1 2 3 Organizing practices 1 2 3 Injury prevention and treatment 1 2 3 Principles for teaching soccer skills 10. Have you ever received treatment for alcohol or drug abuse? Yes 11. Have you ever had charges brought against you for child molestation, abuse or neglect? 3
Yes 12. Do you have any first aid training? Yes 13. Please list the name, address and telephone number of two persons who know you sufficiently well to comment on your past coaching or your potential as a coach. Name Address Telephone Number 14. Have you ever been arrested or convicted of an offense against the Law other than a minor traffic violation? Yes No If yes, please explain fully on an additional sheet. WYSL Coaching Requirements OTHER COMMENTS: (list other comments that you may consider appropriate) 4
I understand that the Board of Directors will select coaches after considering, among other things, the following: (a) (b) (c) (d) The interests of the players; The demonstrated ability of the coach to work with children in an orderly and constructive manner; The performance of the coach, including, but not limited to, the teaching of skills and, directly and by example, of sportsmanship and team play, and the overall degree of fairness and objectivity with which the coach treats all players; The expressed opinions, positive or negative, of players, parents, referees or other coaches. I also understand that the time commitment required for being a coach in the Harrison Youth Soccer Club includes, but is not limited to, running a practice at least once per week during the season, coaching games on Sundays, regularly communicating with the parents of players and the Club s Board and taking care of related administrative responsibilities. If accepted for a coaching position, I hereby acknowledge that if appointed I will serve at the pleasure of, and agree to abide by the rules and regulations of, the Harrison Youth Soccer Club. I understand that the information which I have furnished herein is subject to verification, which may include a criminal background check and reference interview. My signature below is my consent to authorize reference interviews and a background check. Date: Signature Email completed form to the HYSC Club VP and Head of Training: hyscclubvp@gmail.com 5