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       Carolina Juniors Volleyball Coach Application              Please fill in the following information and then click SUBMIT at the bottom of the page.
 
PO Box 470881 * Charlotte  NC  28247 * 704-583-1444 (Phone) * 704-583-6112 (Fax)
PERSONAL INFORMATION
 Name
Address
City State Zip
 Email
Home Phone
Cell Phone
Birth Date   Age  Sex
Social Sec. # License #
Employer Wk Phone
Work Address
City State Zip


COACHING POSITIONS
Carolina Juniors
Programs		 I would like to be considered for a PRACTICE & PLAY Coach.
I would like to be considered for a NON-TRAVELING Team Coach.
I would like to be considered for a TRAVELING Team Coach.
I would like to be a volunteer to help when I am available.


ADDITIONAL PERSONAL INFORMATION
Car Insurance Driving Record Do you hold a valid driver's license?   YES  State    NO
  
Have you ever had a driver's license suspended or revoked?  YES  NO   
If yes, reason
Background Information Have you ever been convicted of a felony or misdemeanor? YES NO    
If yes, please state date and explain conviction:
  
Have you ever been cited or convicted of a driving violation involving alcohol, drugs or negligent driving? YES NO  If yes, please explain:
 
Have you ever been terminated or asked to resign from a job? YES NO  
 If yes, Please explain :

A background check may be performed on Traveling Team Coaches. By filling out this form, you are consenting to this background check process, recognize that fraudulent statements on the above information may be violations of the USA Volleyball Code Of Conduct and  are subject to the infraction policies found on your USAV membership application.