2016 Coach Resume
Team Name: ___________________________________ Team Number: _______________________
Week attending Cooperstown Dreams Park: _________________________________________________
City: _____________________________ State: __________ ZIP Code: ________________________
Home Phone: ____________________________ Business Phone: ______________________________
Date of Birth (mm/dd/yy):____/____/____ Social Security Number: ______-____-______
(Must be 18 years of age or older – under 18 cannot be placed in a supervisory position)
Occupation: ______________________________ Employer: __________________________________
Community Affiliations (church, clubs, service organizations, etc.): ________________________________
Previous Youth Experiences (coaching, teaching, youth organizations, scouting, etc.): __________________
Special Certifications (CPR, Medical, etc): ____________________________________________________
Have you ever been convicted of a felony or do you presently have a criminal action pending against you?
NO If yes, describe each in full: ___________________________________________
Please list three (3) references and their daytime phone numbers, all references must have knowledge of your
participation as a coach/teacher in youth programs (No immediate family members/relatives can be provided):
(please print legibly)
Daytime Phone Number
1. _________________________/______________ _________________________________
2. _________________________/______________ _________________________________
3. _________________________/______________ _________________________________
As a condition of being a coach at Cooperstown Dreams Park, I give Cooperstown Dreams Park, Inc. permission
to conduct a background check on me, which may include a review of sex offender registries, child abuse and
criminal history records. I understand that, if accepted, my status is conditional upon Cooperstown Dreams
Park receiving no inappropriate information on my background. I hereby release and agree to hold harmless
from liability Cooperstown Dreams Park, the officers, representatives or any other person or organization that
may provide such information. I understand that I am subject to suspension and removal by Cooperstown
Dreams Park for violation of Cooperstown Dreams Park rules or policies.
I, ____________________________ (print name) do certify under penalty of perjury that the above information
is complete and accurate.
Coach Signature: __________________________________________ Date: ____________________
IF ADDITIONAL SPACE IS NEEDED TO ANSWER QUESTIONS PLEASE USE THE BACK OF THIS FORM.
For Cooperstown Dreams Park Use Only: Resume Check completed by:
Director Signature: ________________ Date: ______________