Adena Futbol Club Coaching Application Position Title: Club Youth Soccer Coach Position Summary: Coaching a youth club soccer team playing at the classic level for two seasons, beginning Fall 2010. Coach will conduct two to three weekly practices during the season. Teams play approximately 10 regular season games plus two tournaments. Name: Street Address: City: State: Zip: Phone: Email: As per KRS 17.160, your application will be processed by the Pretrial Services, Administrative Office of the Courts.  The following information is required to conduct the background check: Maiden Name (or Alias): Social Security Number: Date of Birth: Coaching Interest: What gender and age groups are you interested in coaching (check all that apply) Girls: All U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 Boys: All U9 U10 U11 U12 U13 U14 U15 U16 U17 U18 U19 Coaching and Soccer Experience: What youth coaching experience do you have? What coaching certifications do you hold (provide state and certification numbers where appropriate)? What clinics or courses have you attended related to coaching or playing soccer? What soccer playing experience do you have? What soccer referee certifications do you (or did you) hold? What other related experience or certifications do you have (such as CPR, First Aid, Youth Leadership, etc)? Please provide coaching references: Name: Contact Info: Name: Contact Info: Name: Contact Info: