2019 Coaching Application

General Information:
First Name: *
Middle Name: *
Last Name: *
Maiden Name:
Aliases/Former Names:
Date of Birth: *
Place of Birth: *
City: *
State: *
Sex: *
Driver License: *
License Current?
Issue State: *
License #: *
Licenses Previous Held in Other States
List State(s)
Current Contact Information:
Email Address: *
Home Phone:
Cell Phone:
Work Phone:
Current Address: *
Current City: *
Current State: *
Current ZIP: *

Previous Addresses, Go Back 10 Years:
Previous City: State: Dates:

Criminal Record:
List any times you pleaded guilty to or were convicted of a criminal violation, excluding minor traffic infractions:

Date: Place: Nature of Offense: Court Location: Disposition:

Are you aware of any information about yourself, which might tend to reflect unfavorably on your reputation, morals, character or ability as a prospective coach for Jackson Youth Football Association? *
If yes, please explain:

Coaching Position Details:
Applying for Coaching Position Type:*
What league are you requesting to coach: *
Name your assistant coaches or the head coach of the team:

Additional Information:
Other pertinent information that you would like the JYFA to know.

References (Optional):
If you wish to list references,
please give name(s) and
phone number(s):
Name: Phone:

Coaches' Code of Ethics:
I hereby Pledge to live up to the Code of Ethics set forth by Jackson Youth Football Association. *
  • I will place the emotional and physical well being of my players ahead of a personal desire to win.
  • I will treat each player as an individual, remembering the large range of emotional and physical development for the same age group.
  • I will do my best to provide a safe playing situation for my players.
  • I will promise to review and practice the basic first aid principles needed to treat injuries of my players.
  • I will do my best to organize practices that are fun and challenging for all my players.
  • I will lead by example in demonstrating fair play and sportsmanship to all my players.
  • I will provide a sports environment for my team that is free of drugs, tobacco, and alcohol, and I will refrain from their use at all youth sports events.
  • I will be knowledgeable in the rules of each sport that I coach, and I will teach these rules to my players.
  • I will use those coaching techniques appropriate for each of the skills I teach.
  • I will remember that I am a youth sports coach, and that the game is for children and not adults.

I hereby certify that the facts set forth in this coaching application are true and correct to the best of my knowledge. I understand that if I falsify statements on this coaching application, I may not be considered for coaching duties.
I hereby authorize the Jackson Youth Football Association or its representatives to conduct an investigation into my background history to verify the above information.
I also further understand that I will abide by all rules, policies, and by-laws of the League and that my actions can be held accountable to any and all of the aforementioned and that I can be suspended, put on probation, or removed from coaching by the Board of Directors per their rules and by-laws.