Concord fc travel soccer coaching application

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Concord FC Travel Soccer Coaching Application

Concord Football Club (Concord FC or CFC) is a spring and fall travel league for players who want a competitive soccer experience. It is the mission and vision of NCSA to provide a highly-qualified coaching staff for that experience. All coaches are required to obtain at least a U.S. Soccer F License before the first game of the current season and are encouraged to advance to a D license. All coaches are subject to a background check per the requirements of New York State West Youth Soccer Association. All coaches will also be required to operate within the Concord FC Coach Policy and will be subject to discipline and/or possible termination without pay for any violation of the policy.

Concord FC is interested in your background and experience with soccer and coaching. This will help Concord FC select coaches who can provide the best environment and most positive learning experience for the players. This information, except any Risk Management questions, will be used to create a small bio on the Northern Chautauqua Soccer Association's website to recognize and promote our coaching staff. Please include a photograph with the application. Thank you in advance for your interest in coaching.

(Place "x" on line where applicable)

I would prefer to be: Head coach ________

Assistant Coach _________

I would like a coaching mentor:

Yes ______ No ______

Age group & Gender desired:

______________________________________________

Name:

_________________________________________________________________________________________________

Address:

_________________________________________________________________________________________________

City/State/Zip: ________________________________________________________________________________________________

Email:

_________________________________________________________________________________________________

Primary Phone: ___________________________________

Secondary Phone: _______________________________

Do you have a child or relative who might play at this level: Yes _________

No _________

If yes, list the child's name: ______________________________________________

1 Coach Initials _______

COACH HISTORY

List all current soccer coach licenses held and soccer coach training completed. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________

List your previous coaching experience, including other youth sports, if any. Note at what levels you've coached, how many years, and in which community/association. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ List your playing experience, if any. Note at what levels you played, and how many years. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Provide a brief description of your main goals as a youth soccer coach and your coaching philosophy for youth athletes. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________

2 Coach Initials _______

INITIAL RISK MANAGEMENT CHECK

Have you ever been ejected or otherwise disciplined for coaching or spectator conduct? If so, give all details.

____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________

Have you ever been arrested or charged with a crime? If so, give all details. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Have you ever been convicted of a crime? If so, give all details. ___________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ _ Have you ever been the subject of a Child Protective Services complaint? If so, give all details. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Have you ever been discharged from employment for cause? If so, give all details. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ Provide any other background information or comments you believe will aid the coach selection process. ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________

Please provide contact information for 2 to 4 references from teams for which you have coached in the past five years. The references should include at least one parent or player. Additional references can be a referee or any other reliable source.

All the information contained in this application is true and accurate and I understand any information found to be inaccurate could result in my immediate removal as a coach for Concord FC.

_____________________________________________________________________

Applicant's signature

Date

3 Coach Initials _______

REFERENCES

Name:

_________________________________________________________________________________________________

Email:

_________________________________________________________________________________________________

Primary Phone: ___________________________________

Secondary Phone: ___________________________

Team Age, Gender, Level, & Club/School: __________________________________________________________

Relationship with team: Parent __________ Player _____________ Referee____________ Other ________

Name:

_________________________________________________________________________________________________

Email:

_________________________________________________________________________________________________

Primary Phone: ___________________________________

Secondary Phone: ___________________________

Team Age, Gender, Level, & Club/School: __________________________________________________________

Relationship with team: Parent __________ Player _____________ Referee____________ Other ________

Name:

_________________________________________________________________________________________________

Email:

_________________________________________________________________________________________________

Primary Phone: ___________________________________

Secondary Phone: ___________________________

Team Age, Gender, Level, & Club/School: __________________________________________________________

Relationship with team: Parent __________ Player _____________ Referee____________ Other ________

Name:

_________________________________________________________________________________________________

Email:

_________________________________________________________________________________________________

Primary Phone: ___________________________________

Secondary Phone: ___________________________

Team Age, Gender, Level, & Club/School: __________________________________________________________

Relationship with team: Parent __________ Player _____________ Referee____________ Other ________

Please email your application to c.witkowski@.

4 Coach Initials _______

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