For Hiring and Payment of Coaches, Summer

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Camp Coach Information Form

CONTACT INFORMATION
First Name Last Name
Identify the Camp Director that hired you (alphabetical by first name)*
*
Street City State Zip
Mobile Cell **
Mobile Cell *
Primary Email*

Primary Email
Date of Birth*

Date of Birth
Social Security No.*

Social Security No.
Driver's License No.*

Driver's License No.
Current Employer/School and Job Title(s)*
Yes, I authorize Pro Sports Experience to conduct a background check on me*
- YES
Emergency Contact First and Last Name

Emergency Contact First and Last Name
Phone Emer Contact or Home
Phone Emer Contact or Home
COACHING BACKGROUND
Briefly, tell us your relevant football coaching experience; highlights
REQUIRED for HIRED COACHES -- INSURANCE INFORMATION
Health Insurance Provider*
Health Insurance Policy #*
Auto Insurance Company*
Auto Insurance Policy #*

CONTACT INFORMATION