DANBURY PAL SOFTBALL - (Danbury, CT) - powered by LeagueLineup.com

Online Coaches & Volunteers Application Form

The information obtained in this form is for the internal use of the Danbury PAL Organization. By filling out this application you are authorizing a police records check to be done by the Danbury PAL.

Personal Information

* First Name:

* Last Name:

* Social Security Number:

* Address:

* City:

* State:

* Zip Code:

* Date of Birth:

* Home Phone:

Cell Phone:

* Email Address:

* Driver's License #:

* Driver's License Expiration Date:

Occupation Information

* Occupation:

* Employer:

* Years of Employment:

* Employer Address:

* City:

* State:

* Zip code:

* Employer Phone Number:

Coaching Experience and References

* Please list coaching experience with youths:

List residence(s) for last 5 years:

Please provide those who are familiar with your character as it related to youths, no family members

* Reference #1 Name:

* Reference #1 Phone Number:

* Reference #2 Name:

* Reference #2 Phone Number:

Reference #3 Name:

Reference #3 Phone Number:

Additional Information

* Do you use illegal drugs?:

* Have you ever been convicted of a criminal offense?:

* Have you ever been charged with child abuse?:

if yes, please explain:

* Has your drivers license ever been suspended or revoked?:

if yes, please explain:

* Other than the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted to provide supervision, guidance and care of young people?:

if yes, please explain:

I UNDERSTAND THAT:

The information that I have provided may be verified, if necessary, by contacting persons or organization names in this application or by contacting any person or organization that may have information on me. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree to hold harmless the organization, local counsel, officers, employees and volunteers thereof.

By checking this box, I affirm that all information I have given is true and correct *

* indicates required fields