Coaches Background Check

COACHES BACKGROUND CHECK
APPLICANT INFORMATION FORM

All information sections listed on this form must be completed. In the event that a section is not applicable, only then can the section be left without an actual data entry. HOWEVER, at a minimum, in these circumstances, N/A must be written in that particular field. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Anyone applying for a Coaches Background Check may contact the Recreation Director or Assistant Township Administrator to discuss the criteria by which the check is performed. An example listing of offenses is available for review by anyone wishing to gain more knowledge of the criteria for background check. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Name (Must be spelled out, no initials)	First Name: Middle Initial: Last Name:
Daytime Telephone Contact Number
Social Security Number
Date or Birth	:
Height
Weight (lbs)
List maiden name if married female:
Place of Birth (State if US Citizen - Country for all others):
Country of Citizenship:
Home Address:	Street City: State Zip
Sex:
Hair Color
Eye Color
Race (Select One)	Asian / Pacific Islander (Includes Asian Indian) Black White (Includes Hispaniz / Spanish Origin) Unknown American Indian / Alaska Native
Occupation:
Employer Name
Employer Address:	Street City: State Zip
Place a check mark next to all sports in which you are involved.	Baseball \| Legion Baseball \| Softball \| Field Hockey \| Soccer \| Travel Soccer Football, Cheering \| Girls Basketball \| Boys Basketball Summer Youth Program \| WJ Witches 10U WJ Witches 12U \| WJ Witches Elite 14U \| WJ Witches 18U Other, Please Specify
E-Mail Address
Date Form Completed (MM/DD/YYYY)

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