Youth Basketball
Coach Application

Full Name
Birth Date
Social Security Number
Current Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
E-mail
Current Place of Employment
Immediate Previous Employer
Phone
Please list any previous states that you have lived in
Please list your experience as a Coach or Assistant Coach (more fields scroll right)
ProgramLocationDatesAge GroupHow Long
What position are you applying for? Head Coach       Assistant Coach
In what league(s) would you prefer to coach?
List any of your children who will be participating in NJCPR basketball
References: Please list three persons who have known you 5 years or longer (more fields scroll right)
NameAddressPhoneYears Known
By accepting below, I am consenting to a criminal background check, to abide by the philosophy and rules of Nicholasville/Jessamine County Parks & Recreation youth basketball, and to conduct myself at all times in a professional and mature manner that reflects well upon Parks & Recreation and that serves as a fine example for the youth I will be coaching. I also fully understand that this application is not a guarantee that I will be given the opportunity to coach.
I Accept These Terms
Date
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402 Park Drive · Nicholasville, KY 40356 · Telephone: 859-885-9787 · Fax: 859-881-5017 · Email: njcpr@windstream.net
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