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Coach Screening Application

  1. Screening 1
    Disqualifying Status Questions – Affirm or Deny Each of the Following Statements Any negative response in this section of this application renders the applicant disqualified from volunteer coaching
  2. I have been criminally convicted or have charges pending for:*
  3. I have had a criminal felony conviction within the last 10 years*
  4. I was incarcerated in federal or state prison in the last 5 years*
  5. I am now on parole/probation to any court, penal institution, or govt. entity, including being under house arrest or subject to a tracking device*
  6. I was criminally convicted of a misdemeanor in the last 7 years involving*
  7. I was criminally convicted of a misdemeanor in the last 3 years involving*
  8. I have an outstanding arrest warrant from any jurisdiction*
  9. I am now subject to a protective order for physical or sexual abuse*
  10. Screening 2
    Discretionary Disqualification: An applicant may be disqualified to work with vulnerable populations on behalf of the department, at the reasonable discretion of the supervising division manager, if any of the following circumstances exist: 1. Applicant has been sanctioned for one or more criminal offenses not described in the section on automatic disqualification and the offense(s) reasonably raises the possibility of risk of neglect, abuse, harm or detriment to vulnerable populations if the same offense(s) or similar conduct were repeated in the presence of the vulnerable populations that applicant will be working with. 2. Applicant has a history of conduct know to the Department of unprofessional, dishonest, unethical, unsportsmanlike, rule-breaking, reckless, or other inappropriate behavior, or violation of court orders, which in the view of the Department demonstrate that vulnerable populations will not be well-serves by supervised interaction with or mentoring by application.
  11. Question regarding Screening 2*
    Do you have a criminal history or any conduct that would prevent you from working as a volunteer coach in our youth program as described above?
  12. Include grade, age and gender
  13. What are you applying to be?
  14. Must include your child. Basketball, flag football and draft division baseball/softball you may freeze 2 players. Soccer and baseball/softball ages 10 and younger you may freeze 3 players. Please read the WFFL By-laws regarding tackle football. High School age sports may have special rules. If you are coaching a division that includes High School age players please see the coordinator of the sport for details. We will compose your roster considering frozen players area schools. Frozen players must be registered within the registration period. To view additional details regarding team composition visit our “Policies and Forms” page on our website www.kaysvillerec.com
  15. As a coach I will comply with the following code of ethics:
  16. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I, the undersigned, do hereby verify, under penalty of perjury, that the information provided herewith is complete, truthful and accurate to the best of my knowledge and belief. I do hereby agree to allow the City to obtain a name/date of birth BCI background check for enforcement purposes. I understand and agree that the League Director has the discretion to choose who will manage/coach. I accept that the League Director has the discretion to suspend or expel a coach for improper conduct.
  17. Leave This Blank:

  18. This field is not part of the form submission.