Classified Paradise Unified School District Certificated _

 Classified Certificated  Paradise Unified School District 6696 Clark Road * Paradise, CA 95969 (530) 872-6400 - Fax 872-6409

APPLICATION FOR COACHING POSITION Name: Position Applying For: Address: Telephone: City/State/Zip: Cell Phone:

I am Certified in care of athletic injuries and first aid and have the following (one is required): Please attach copies.  College class in athletic training plus CPR Date Completed:  Sports injury certificate for first aid card plus CPR Expiration Date:  EMTI or EMTII card Expiration Date:  Trainer’s certificate (NATA or CATA) Expiration Date:

CHILD/ADOLESCENT PSYCHOLOGY:  Completed college class  Completed seminar/workshop on human growth and development of youth  Prior work with kids in school or community sports programs

Valid California Driver’s License?  No  Yes, CDL#: ______Exp.Date: ______Have you ever been on a Retirement System?  Yes  STRS? PERS?  OTHER? ______ No  Refunded?  Retired? Education:  Graduated from Elementary School/__ Did not graduate but completed __ years.  Graduated from High School/__ Did not graduate but completed __ years.  Have a two-year college degree.  Have four-year college degree: ______ Have Master's degree: ______ Do not have degree, but have __ years of college.  Have indicated degree plus __ units.

California Credentials now held Attach copies of credentials, if possible): Expiration Date(s):

Has your credential ever been suspended or revoked?  Yes  No

List any courses, seminars, workshops you have taken in addition to the above education: ______

Licenses, registrations, or certificates of professional competence: ______

Membership in coaching associations: ______

Have you ever pleaded guilty or been convicted of any crime other than a minor traffic violation? Yes  No (State law requires that all applicants prior to employment be fingerprinted and prohibits employment of any person convicted of certain sex and controlled substance offenses.) Except for the preceding, conviction is not an absolute bar to employment. Failure to reveal convictions is grounds for immediate termination. Have you resigned from or otherwise left public or private school employment to avoid Yes  No investigation for alleged misconduct and/or dismissal in California or any other state or place? Are you now the subject of any inquiry, disciplinary action, review or investigation, in any district, Yes  No or in the court of California or any other state in connection with any alleged misconduct? A “yes” answer to any of the above questions is not an absolute bar to employment. If you have Yes  No answered “yes” to any of the questions above, you may wish to attach additional page(s) explaining your answer(s) For each question answered yes, explain in writing the circumstances and attach hereto. ______

WORK EXPERIENCE: Please list your coaching experience, recent experience first: Name of Employer ______Address ______Position Held ______Immediate Supervisor ______Date Hired ______Date Left ______Reason for Leaving ______Describe duties ______

Name of Employer ______Address ______Position Held ______Immediate Supervisor ______Date Hired ______Date Left ______Reason for Leaving ______Describe duties ______

References: Please list 3 individuals who have directly observed or supervised your coaching. Name Title/Position Address City/State/Zip Phone

Pursuant to the Immigration and Reform Act of 1986, I understand that an offer of employment made to me will be conditional on my ability to provide evidence of my legal right to work in the United States. I understand that falsification of information on this application and supporting materials is grounds for discipline including dismissal and/or termination of employment. I hereby certify that the foregoing information is accurate in all respects, and I authorize investigation of all statements herein recorded. All listed references and previous employers may be contacted. I release from all liability persons and organizations reporting information required by this application.

Dated: ______Signature:______

Paradise Unified School District is an equal opportunity employer. Applications will remain on file for six (6) months--On request, we will keep them active for a longer period.  For more information please visit our web site at: www.paradise.k12.ca.us Please include: I heard of this opening from (source): ______

__ Classified Paradise Unified School District Certificated ___

Classified Paradise Unified School District Certificated _