| YMCA of Middle Tennessee Youth Sports Volunteer Application |
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| Name:__________________________________________ D.O.B.:_______________ Sex:_______ Current Address:____________________________ City/State/Zip:__________________________ Phone: Home:______________ Office:_____________ Cell:______________ Fax:_____________ How long have you lived at this address?_________Social Security #:________________________ E-Mail Address:___________________________________________________________________ Emergency Contact (permanent/parent's home information if you are a student) Title:_________________ Name:_______________________ Relationship:___________________ Address:_________________________________________________________________________ Phone: Home:______________ Office:_______________ Pager:______________ Background information Please list here any other names you may have used in the past:____________________________ Driver's licence #:_________________ State Issued:_____ Driver's licence classification:_________ Have you ever been convicted of a criminal offence? YES / NO Residences Please list at least 3 years of residence history (excluding your current address) starting with the most recent: 1.______________________________________________________________________________ Street address City State Zip From month/yr. to month/yr. 2.______________________________________________________________________________ Street address City State Zip From month/yr. to month/yr. 3.______________________________________________________________________________ Street address City State Zip From month/yr. to month/yr. Employment History Please list your last two employers starting with the most recent: 1.______________________________________________________________________________ Name of Organization/Company Employed from month/yr. to month/yr. ________________________________________________________________________________ Street address City State Zip Telephone ________________________________________________________________________________ Job title and describe your work ________________________________________________________________________________ Name and title of immediate supervisor 2.______________________________________________________________________________ Name of Organization/Company Employed from month/yr. to month/yr. ________________________________________________________________________________ Street address City State Zip Telephone ________________________________________________________________________________ Job title and describe your work ________________________________________________________________________________ Name and title of immediate supervisor Education Note: Formal education is not required to be a volunteer. We welcome experiences of all kinds! Highest level completed____________________ Degree or diploma__________________________ Name and location______________________________ Course of study______________________ Interests How did you learn about the volunteer opportunities at the YMCA of Middle Tennessee?_____________________ Why would you like to volunteer?__________________________________________________________ What other organizations have you volunteered for, if any?_________________________________________ Type of Volunteer position you are applying for _____Head Coach _____Assistant Coach _____Other____________________________ What sport are you applying for? _____Soccer _____Basketball _____Other__________________ ALSO COMPLETE AND SIGN THE OTHER SIDE References List 3 people who have known you for at least 3 years whom you authorize us to contact. Include one family member. 1.) Name:____________________________________Phone:_______________________________ Address:__________________________________ City/St/Zip____________________________ Relationship to you:_________________________ Known you for how long:_________________ 2.) Name:____________________________________Phone:_______________________________ Address:__________________________________ City/St/Zip____________________________ Relationship to you:_________________________ Known you for how long:_________________ 3.) Name:____________________________________Phone:_______________________________ Address:__________________________________ City/St/Zip____________________________ Relationship to you:_________________________ Known you for how long:_________________ STATEMENTS of UNDERSTANDING. Please initial each statement and sign. ____1. I understand that the YMCA of Middle Tennessee Sports Coaches Manual will apply to me and I will be given a copy upon begining my volunteer service. ____2. I understand that the YMCA does not discriminate based on race, color, creed, religion, national origin, sex, marital status, status with regard to public assistance, membership or activity in a local commission, disability, age or other legally protected status. ____3. I understand the YMCA reserves the right to conduct criminal background and reference checks on all volunteers. I hereby give my permission for the YMCA of Middle Tennessee to obtain information relating to my criminal history record. The criminal history record, as received from the reporting agency, may include arrest and convictions. I understand that this information will be used, in part, to determine my eligibility for a volunteer position with the YMCA of Middle Tennessee. I also understand that it will be repeated on a monthly basis. I will have an opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received. ____4. I understand that the YMCA nor its agents, employees, servants or invitees shall be liable to me or any of my family, agents, employees, servants or invitees for any damage to persons or property when and to the extent that any such damage or injury may be caused. I will not hold the YMCA responsible for any injuries or accidents that may occur. _____________________________________ ____________________________________ Signature Date Printed name of applicant Our Mission: A worldwide charitable fellowship united by a common loyalty to Jesus Christ for the purpose of helping persons grow in spirit, mind and body. |