Coaching Application
Application Date: ______________

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Last First Middle

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Street City State Zip

SSN: _________________ Home Phone: ________________ Other Phone: ________________

Please list any BHS players or BHS Board members you are related to:

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Specify level (s) you are most interested in coaching

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Previous Experience:

List previous coaching positions:

1.

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Position Reference Contact Phone number

2.

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Position Reference Contact Phone number

3.
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Position Reference Contact Phone number

List any specific skills, experiences, or relevant training:

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Prior Events:

Please check YES or NO for each question

Have you ever been discharged from a coaching position before? [ ] No [ ] Yes If yes, explain

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Have you ever been convicted of any violation of law, except minor traffic violations? [ ] Yes [ ] No

If yes, please explain

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Coaching Certifications:

Coaching certifications you currently hold: (Please attach copies of all valid and current certifications)
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ASEP Certification (American Sport Education Program) [ ]Yes [ ] No

First Aid Certification [ ]Yes [ ] No CPR Certification[ ]Yes [ ] No

Agreement and Acknowledgement: (Read carefully before signing.) All information provided by me is true and correct to the best of my knowledge. I understand omissions misrepresentations may result in rejection of my application or, if retained, may result in my subsequent dismissal. I hereby authorize any former person, school district, firm or corporation listed, including the District, to answer any and all questions related to my employment as an athletic coach and agree to release from liability and hold all persons harmless for giving any and all truthful information within their knowledge or records. I understand this is a preliminary application and not a contract to employ me.

If I am retained to fill this position, I understand I will have to complete any certifications needed to fulfill the requirements of a certified coach. If I do not complete said training, it will be cause for dismissal.

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Applicant Signature Date

Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to race, color, national origin, religion, age, sex, disability, or any other factor prohibited by law.

Return completed application to Sheri Heinz, 1303 Westminster Drive, Brookings, SD 57006 or email to sheriheinz@mchsi.com. (605) 692-4881