HARFORD COUNTY PUBLIC SCHOOLS HUMAN RESOURCES OFFICE 102 S. HICKORY AVENUE BEL AIR, MD ~ Fax:

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1 HARFORD COUNTY PUBLIC SCHOOLS HUMAN RESOURCES OFFICE 102 S. HICKORY AVENUE BEL AIR, MD ~ Fax: COACH APPLICATION Position Applying For: Temporary Emergency Coach Volunteer Athletic Coach PERSONAL INFO : Address: Home City/State/Zip Code: Work address: Cell If you are offered employment by Harford County Public Schools, can you submit verification of your legal right to work in the United States? Yes No PLACEMENT INFORMATION (Check only those for which you qualify) CHECK TYPE OF POSITION DESIRED MINIMUM REQUIREMENTS VARSITY HEAD COACH VARSITY ASSISTANT COACH JUNIOR VARSITY HEAD COACH Special Skills: Baseball Basketball Cheerleading Cross Country Field Hockey Football Golf Must be at least 21 years of age* Completion of Care and Prevention of Athletic Injuries class* Completion of CPR and AED training* Must attend Seasonal Harford County Coaches Meeting Completion of National Federation of State HS Associations (NFHS) online concussion course* * Verification required Lacrosse Soccer Softball Swimming О Life Saving О Pool Operator О Water Safety Instructor Tennis Track/Field Volleyball Wrestling Available start date: Have you previously submitted an application for employment with Harford County Public Schools? If yes, please provide date: In which school do you prefer to work? Yes No Position applied for: Have you previously worked for Harford County Public Schools? If yes, please state employment dates: Yes No Position held: Location: Reason for leaving: Fingerprint/Background Check Requirement: Signature of the school s Athletic Director is required prior to the scheduling of an appointment with the Office of Internal Investigations. Athletic Director (Print) Signature of Athletic Director Date

2 EDUCATION RECORD High School and address Dates Attended College or University and address of college, university or professional school Dates Attended Other Training/Certification Dates Attended Year of Graduation Did you complete the course? Date Awarded High School Equivalency Diploma (GED) If Degree Not Achieved Degree and Subject Area Have you attended the MPSSA Rules Clinic for the sport in which you wish to coach? If yes, please provide date: Highest Grade Successfully Completed Years Completed or Credit Hours Certification or License Yes Expiration Date No Location: Have you completed or are you enrolled in the equivalent of one-credit course in the prevention/care of athletic injuries? Yes If yes, please provide date: Location: Please describe why you feel you can be effective coaching youth: 2 No

3 EMPLOYMENT RECORD List present or last employment position first. List complete employment history (high school to present). Account for all breaks in employment. Give complete mailing address for all employment history. Include military service. Attach additional sheet if needed. Date of Employment (Month/Year) Employer Employer's Address Employment Information From Position To Type of Business Reason for Leaving Supervisor's Salary Duties Performed: From Position To Type of Business Reason for Leaving Supervisor's Salary Duties Performed: From Position To Type of Business Reason for Leaving Supervisor's Salary Duties Performed: REFERENCES Please provide complete information for a minimum of two professional references, who have known you for a minimum of three (3) years. Family members and friends are not acceptable professional references. Occupation and Years Acquainted Occupation and Years Acquainted Occupation and Years Acquainted 3

4 CONVICTION OR DISMISSAL Have you ever been convicted or received probation before judgment for a crime? (Do not include minor traffic violations for which a fine of $100 or less was imposed.) Yes Have you been charged with a crime and/or are awaiting trial? Yes No Have you ever been dismissed, asked to resign, or refused reemployment? Yes No Have you ever been investigated or charged with any offense relating to children? Yes No In any previous employment experience, have you ever received an oral or written reprimand? Yes No No If your answer to any of the five questions is "yes", please provide details on a separate sheet of paper. IMPORTANT NOTE: If the answers to the above questions change after the date you originally sign this application, you must immediately notify the Human Resources Office in writing of the nature and reasons for those changes. PLEASE READ CAREFULLY I understand that everyone hired by Harford County Public Schools is fingerprinted and subject to a criminal background check. In addition, I understand that I may be subjected to a pre-employment physical. I also understand that unsatisfactory results from these pre-employment checks will result in withdrawal of any employment offer or termination of employment if already employed. I understand that acceptance of this application does not constitute an employment agreement. I am at least 21 years of age. I understand that Temporary Emergency Coaches and Volunteer Coaches are appointed on a one season basis for a specific coaching assignment. I hereby affirm that the information given by me in this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission will be sufficient cause for cancellation of the application or discharge, if I have been employed. The Human Resources Office has my permission to contact all past and present employers. Signature of Applicant Date LIE DETECTOR TESTS (Article 100, Section 95, Annotated Code of Maryland) "Under Maryland law an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100." Signature of Applicant Date AN EQUAL OPPORTUNITY EMPLOYER The Harford County Public School System does not discriminate on the basis of race, color, sex, age, national origin, religion, sexual orientation, marital status, genetic identification, political affiliation, or disability in matters affecting employment or in providing access to programs for employees. Inquiries related to the policies of the Board of Education of Harford County should be directed to the Manager of Communications, /2011 (A-COH1)

5 Harford County Public Schools HUMAN RESOURCES OFFICE 102 S. Hickory Avenue, Bel Air, Maryland * Fax: DIRECTIONS REGARDING COACH REFERENCES References are very important in processing and evaluating your application for employment. References should be individuals who are best qualified to give evaluation of your success or potential success with Harford County Public Schools; therefore, your immediate supervisor(s) must be listed. It is your responsibility to send the reference form to the individuals you record on the application; a minimum of two references are required. Be sure to complete your name and the position you are seeking on the form prior to forwarding to your references. We strongly suggest that you provide stamped/addressed envelopes; please instruct the individuals to mail the completed form directly to the Human Resources Office in the provided envelopes. We cannot complete the evaluation of your application until our office has received all reference forms. Please distribute the forms as soon as you submit your application to our office. Feel free to contact our office at if you have any questions regarding this process. Rev. 7/2011 (A-COA2)

6 Harford County Public Schools Human Resources Office 102 S. Hickory Avenue, Bel Air, Maryland ~ Fax: COACH APPLICANT REFERENCE Reference To: Applicant: Position/Activity Applied For: The above-named person has applied for employment with the Harford County Public School System. Please evaluate this candidate in comparison to others you have known in a like position. Your response is strictly confidential, unless subpoenaed by a court. The reference responses are important to us in evaluating qualifications and determining possible placement. RELATIONSHIP TO APPLICANT: Employer Former Employer Co-worker Immediate Supervisor Other POSITION APPLICANT HELD WITH YOUR COMPANY: Outstanding Very Good Average Unacceptable Unknown Attitude Toward Children - understanding, empathetic Coaching Skills - uses a variety of methods Co-worker Relations - friendly, cooperative, tactful Consistently demonstrates appropriate behavior Knowledge of Sports Work Habits - positive attitude, self-motivated Communication - gives clear information and direction Organization - completes tasks easily and efficiently Character - dependability, values, habits Enthusiasm Leadership - initiative, flexibility and ability to manage groups of young people If a former employee please state reason for leaving employment: Please complete one of the following: Enthusiastically recommend Recommend Recommend with reservations* Do not recommend* *PLEASE PROVIDE BRIEF STATEMENT ON REVERSE SIDE Coaches have an influence on the development of attitudes and values of students. This influence can have a significant effect on a student s life. Please indicate your reaction to having your own child associated with this applicant. Very pleased Satisfied Reservations : Title: Address: Employer (if applicable): City, State, Zip: Phone Number: Signature: Date: Do not recommend The Harford County Public School System does not discriminate on the basis of race, color, sex, age, national origin, religion, sexual orientation, marital status, genetic identification, political affiliation, or disability in matters affecting employment or in providing access to programs to employees. Inquiries related to the policies of the Board of Education of Harford County should be directed to the Manager of Communications, /2011 (A-COA3)

7 Harford County Public Schools Human Resources Office 102 S. Hickory Avenue, Bel Air, Maryland ~ Fax: COACH APPLICANT REFERENCE Reference To: Applicant: Position/Activity Applied For: The above-named person has applied for employment with the Harford County Public School System. Please evaluate this candidate in comparison to others you have known in a like position. Your response is strictly confidential, unless subpoenaed by a court. The reference responses are important to us in evaluating qualifications and determining possible placement. RELATIONSHIP TO APPLICANT: Employer Former Employer Co-worker Immediate Supervisor Other POSITION APPLICANT HELD WITH YOUR COMPANY: Outstanding Very Good Average Unacceptable Unknown Attitude Toward Children - understanding, empathetic Coaching Skills - uses a variety of methods Co-worker Relations - friendly, cooperative, tactful Consistently demonstrates appropriate behavior Knowledge of Sports Work Habits - positive attitude, self-motivated Communication - gives clear information and direction Organization - completes tasks easily and efficiently Character - dependability, values, habits Enthusiasm Leadership - initiative, flexibility and ability to manage groups of young people If a former employee please state reason for leaving employment: Please complete one of the following: Enthusiastically recommend Recommend Recommend with reservations* Do not recommend* *PLEASE PROVIDE BRIEF STATEMENT ON REVERSE SIDE Coaches have an influence on the development of attitudes and values of students. This influence can have a significant effect on a student s life. Please indicate your reaction to having your own child associated with this applicant. Very pleased Satisfied Reservations : Title: Address: Employer (if applicable): City, State, Zip: Phone Number: Signature: Date: Do not recommend The Harford County Public School System does not discriminate on the basis of race, color, sex, age, national origin, religion, sexual orientation, marital status, genetic identification, political affiliation, or disability in matters affecting employment or in providing access to programs to employees. Inquiries related to the policies of the Board of Education of Harford County should be directed to the Manager of Communications, /2011 (A-COA3)

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