North Jefferson Junior Baseball Association


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December 25, 2009 4:53 PM

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Space Coach Application and
Release and Disclosure for Criminal Background Check

Final Coaches approval and selection is in accordance with NJJBA Rules and Regulations.
Personal Information
Last Name: First Name: Middle:
Current Address: City: State:
Zip Code: Length of Residency at Current Address (in years): 
 
Please list any other previous residences for the last 7 Years (City and State are required):
Dates (mo/yr) Street Address City State Zip Code
 
Home Phone: Work Phone:
Cell Phone: Fax Number:
Date of Birth (mm/dd/yy): Email:
Occupation: Employer:


Coaching Experience
Have you coached baseball before?
If “Yes”, where did you coach?
At what level did you coach baseball?
For how many years have you coached baseball?
Baseball Experience
(Hold the <Ctrl> key for multiple selections):
Other Coaching/Playing Experience:


NJJBA Position Request
Position applying for: Head Coach
Assistant Coach 		High School Area:
If Assistant, name of Head Coach or enter "Head" or "Unknown":
Age group applying for (Hold the <Ctrl> key for multiple selections): League level applying for (Hold the <Ctrl> key for multiple selections):


Release and Disclosure
Please read the following:

If selected to coach the youth in NJJBA:
  • I agree to instruct, maintain and uphold good sportsmanship
  • I agree to teach the fundamentals of baseball
  • I agree to abide by the By-Laws, Rules, Regulations and Policies of Jefferson County Junior Baseball League and specifically, NJJBA
  • I agree and am obligated to be represented at all coaches meetings
  • I agree to volunteer a minimum of eight (8) hours annually (other than coaching) to assist NJJBA as a whole
  • I agree to achieve all coaching certifications as required by NJJBA
  • I agree to withhold NJJBA from any legal involvement should I be injured while performing my duties in NJJBA
  • I understand that failure to comply with any of these obligations can result in my immediate removal as a coach in NJJBA
I have read and understand my obligations of being a coach in NJJBA: Yes No
Have you ever been convicted of, or forfeited any collateral for any Felony Violation? Yes No
 
By entering your signature below and clicking on the Submit button, you hereby agree to the terms of the Disclosure information and the Coaches Selection criteria as defined by the North Jefferson Junior Baseball Association Rules and Regulations.
 
As part of the application process for Coaching in the North Jefferson Junior Baseball Association (NJJBA) and the Jefferson County Junior Baseball League (JCJBL), I understand that they and/or its agents may conduct an investigation of my personal information. The investigation might include, but is not limited to, criminal history records (from state, federal and other agencies). I understand that these records may be used for the eligibility of my Coaching within NJJBA and JCJBL. I authorize without reservation the full release of these records and for NJJBA and/or its agents contacted by NJJBA to obtain information.

In addition, I release and discharge NJJBA, JCJBL and all of its agents and associates, any expenses, losses, damages, liabilities, or any other charges or complaints for the investigative process. I also authorize the full release of the information described above, without any reservation, throughout any duration of my coaching experience at NJJBA and/or JCJBL. I also certify that all information provided is correct on the application to the best of my knowledge. Any false statements provided will be considered just cause for termination of my coaching privileges.
 
Signature: Date: SSN:


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North Jefferson Junior Baseball Association | P.O. Box 740267 | Arvada, CO 80002
303-422-7406 - Office | 303-456-1566 - Fax
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