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Plymouth South Youth Football and Cheerleading

Application for coaches, assistant coaches and administrators

 

___________________________      ___________________________      __________________________

              last name                                  first name and middle initial                    maiden name

 

 

___________________________      ___________________________      __________________________

            Date of birth                                social security number                         home phone

 

 

___________________________      ___________________________      __________________________

            Street address                              city/town                                             state and zip code

 

 

___________________________      ___________________________      ___________________________

            e-mail address                                     cell phone                                            employer                    

 

Previous residences for the past five years:

 

City______________________________    State___________________

 

City______________________________     State___________________

 

  1. Background in work with youth:  ________________________________________________________

    ___________________________________________________________________________________

 

   2.  Experience in football/cheerleading:  _____________________________________________________

            ____________________________________________________________________________________

 

I understand that:

 

1.      In applying for a Plymouth South Youth Football position, the information which I have furnished on this form is subject to verification, which will include a criminal history check (CORI) from the Central Registry of DSS for child abusers, and/or request of sexual offender listing verification.  The applicant hereby authorizes Plymouth South Youth Football to obtain such information from the appropriate municipal, count, state or federal agency.  This information will be kept in a secure location and appropriately destroyed when no longer needed.

2.      If Plymouth South Youth Football comes in possession of verified information that a volunteer has a history of complaint(s) of physical or sexual abuse of a minor, Plymouth South Youth Football will deny participation in its program.  Plymouth South Youth Football may deny membership to any person, upon review of unordinary circumstances or events, at the Board’s sole discretion.  If for any reason you are denied membership you have the right to appeal the decision to the PSYF Board of Directors.

 

Signature___________________________________________  

 

Date_____________________________________________ __