Submit completed application to the Athletic Director at the school for which you are applying to coach.
Rowan-Salisbury School System Non-Faculty Coaching Application
Please complete both pages of this application in your own handwriting.
Personal Information
Name ___________________________________________________________________________________________________
Preferred Title
First
Middle/Maiden
Last
Nickname
Address_________________________________________________________________________________
City ________________________________________ State ____________ Zip Code _________________
Home Phone No. ___________________________ Alternate Phone No. ____________________________
E-Mail Address ______________________________________ [ ] Former Employee
Preferences in Non-Faculty Coaching Position
School Year ______________
Check One:
Check One:
[ ]Boys
[ ]Girls
[ ]Head
[ ]Varsity [ ]7th
[ ]Assistant [ ]JV
[ ]8th
Check One:
Check One:
Check One:
Check One:
Check One:
[ ]Boys
[ ]Girls
[ ]Head
[ ]Varsity [ ]7th
[ ]Assistant [ ]JV
[ ]8th
Check One:
Check One:
[ ]Boys
[ ]Girls
[ ]Head
[ ]Varsity [ ]7th
[ ]Assistant [ ]JV
[ ]8th
Check One:
[ ]Boys
[ ]Girls
[ ]Head
[ ]Varsity [ ]7th
[ ]Assistant [ ]JV
[ ]8th
Check One:
[ ]Fall [ ]Spring
[ ]Winter
Sport: __________________________________________________
Check One:
Check One:
Check One:
[ ]Fall [ ]Spring
[ ]Winter
Sport: __________________________________________________
Check One:
Check One:
Check One:
School ________________________________________________
Check One:
[ ]Fall [ ]Spring
[ ]Winter
Sport: __________________________________________________
Check One:
Check One:
[ ]Fall [ ]Spring
[ ]Winter
Sport: __________________________________________________
Employment History
Dates
From-To
(Mo/Yr)
/
/
/
/
/
/
/
-
/
Name of School/Organization/Employer
Location of School/
Organization/Employer
Duties
1.
2.
3.
4.
References
Please list at least three references that have first-hand knowledge of your professional ability, experience, and competence. Please include names of
your current and last employers. References from relatives or persons who can only evaluate your personality and character are not acceptable.
Name
Position
Telephone Number(s)
Mailing Address
1.
2.
3.
4.
Revised 4/22/15
Additional Information
Please Check Appropriate Answer:
Yes
[ ]
[ ]
[ ]
[ ]
No
[ ]
[ ]
[ ]
[ ]
Have you ever been suspended, dismissed, fired, or discharged from a position of employment?
Have you ever been subject to disciplinary action during a period of employment?
Have you ever been asked to resign from a position of employment?
Have you ever been convicted or pleaded nolo contendere (no contest) to any violation of the law other than a minor
traffic ticket?
[ ] [ ] Do you have any criminal charges or procedures pending?
If your answer to any of the above question is yes, please explain below or attach a separate sheet.
Applicant’s Statement
I, the applicant/employee hereby expressly authorize the Board of Education, its agents, and its employees to make any investigation of my personal
or employment history, expressly including, but not limited to, federal and/or state criminal, law enforcement, or traffic records, which may include
confirmation by fingerprint identification. I further authorize any former employer, person, firm, corporation, credit agency, administration body, or
governmental agency to give the Board of Education, or its agents, or its employees any information they may have regarding me. I hereby release
the Rowan-Salisbury School Board of Education to which this application is submitted and any and all providers of information to whom this
release is sent, from any liability as a result of furnishing or receiving this information.
I have read the information contained in the application carefully and certify that the information I have given is correct and complete. I understand
that if I am employed, false statements on this application shall be considered sufficient cause for dismissal.
I understand that, if approved, I will be coaching on a volunteer basis. I also understand that a criminal background check and checks of state and
national sex offender registries are required prior to my approval for this position. My time and service in this capacity are given without promise,
expectation or receipt of any form of compensation, benefits or other remuneration for this service. Any receipt of compensation, benefits or other
remuneration for this service will be considered a nominal fee. I will follow all policies of the Rowan-Salisbury Schools, the North Carolina High
School Athletic Association, and the North Carolina State Board of Education Athletic Rules and Regulations in the completion of my duties. I
understand that my participation as a volunteer may be terminated at any time, without cause, and that I may withdraw from participation
at any time for any reason. This agreement will continue in force for the duration of the _______ school year unless earlier terminated.
Other Requirements – The following must be completed before providing ANY ATHLETIC DUTIES OR SERVICES:
1. Hiring requirements
2. NFHS Fundamentals of Coaching course must be completed and certificate on file.
3. NFHS Concussion in Sports course must be completed and certificate on file.
Applicant’s Signature
Date
Principal Approval
I verify that I have been unable to employ a bona-fide faculty or an instructional staff member of our local education agency for appointment
to the needed coaching position(s). I further verify that the above named applicant has been informed of the North Carolina High School
Athletic Association, North Carolina State Board of Education Athletic Rules, and Rowan-Salisbury Schools Athletic Policy and
Regulations.
I recommend this applicant as a Volunteer Coach for (Sport):________________________________for the __________school year.
Check one: [ ]Volunteer-NO Pay [ ]Volunteer-Stipend
Athletic Director’s Signature ______________________________________
Date _________________________
Principal’s Signature _____________________________________________
Date _________________________
The Rowan-Salisbury School System is an equal opportunity and does not discriminate on the basis of race, color, gender, religion, age, or handicapping condition.
FOR CENTRAL OFFICE USE ONLY
[ ] Background Check Cleared
ID _________________________
Start Date __________________________
County Athletic Director’s Signature ___________________________ Date: ___________________
Exec. Director/HR Signature ________________________________ Date ___________________
Revised 4/22/15