Nagel Middle School Track Coach and Assistant Coach

Coaching/Consultant Application for Employment

(Paid or Volunteer)

Complete the application in its entirety and return to the Athletic Office

at the school in which you are applying.

Applying for:

____

Position

Building

Name:

____

First Middle Last

Address:

_____

Street City State Zip

Phone:

______

Email:

____

Home Cell

Are you a Certified Teacher: Please check: Yes__ No__ If yes, please answer the following:

What is your highest level of education? _____ How many semester hours total do

you currently have? ____

Briefly state your qualifications and why you are interested in this position:

_____

_____

_____

_____

_____

List any other sports/positions you are interested in and qualified to coach

:

___

_____

Please indicate which of the following you currently hold:

Credential

Expiration Date

ODE ID #

Valid Ohio teaching license

Valid Ohio Pupil Activity Permit

CPR certification

Education/Employment:

Name

City/State

Dates - From/To

High School Attended

College Attended

Most Recent Employer

Turn Over - Must Complete Other Side

List 5 references (at least 3 must be professional references):

Name

Relationship

Telephone #

Email

List all paid experience in the sport for which you are applying to coach. If more space is needed,

attach a separate page.

Location

Position

Name/Phone # of Supervisor

Dates - From/To

In accordance with Ohio Revised Code §3319.39 and Board of Education policy, all applicants are

subjected to criminal background checks. You are hereby notified that you may be disqualified from

employment if you have pleaded guilty to or have been convicted of certain criminal offenses as provided

by law. Applicants may be hired conditionally pending receipt of a background check. If the background

check indicates that the applicant has one or more disqualifying offenses, the applicant will not be hired

and any conditionally hired applicant will be released from employment immediately. No person who

may be responsible for the care, custody, and/or control of a student can be employed if the applicant has

been convicted of any of the disqualifying offenses listed under R.C.3319.39, 3319.31, and OAC

3301-20-01.

By signing below, I acknowledge that the information provided in this application is accurate. Additionally, I

understand the requirements of the position for which I am applying, including the need to obtain a satisfactory

background check and Pupil Activity Permit (PAP), as issued by the Ohio Department of Education,

prior

to working with

student athletes. If I do not obtain a satisfactory background check, PAP and/or meet any other conditions of

employment, I understand Forest Hills may release me from any offer of employment.

I clearly understand that I am not allowed to work directly with student athletes until I have been Board-approved

and/or conditionally hired.

______

Signature Date

Forest Hills Schools does not discriminate nor tolerate harassment in its employment opportunities,

educational programs or activities

for any reason including on the basis of race, color, religion, national origin,

sex, disability, military status, ancestry, sexual orientation, age or genetic information.

Individuals with certain criminal history will be disqualified from employment with the Forest Hills School District.