FNSW State Titles Coach EOI

Football NSW State Titles Coaching Expression of Interest
Coach's Name*

First NameLast Name
Date of Birth*

DayMonthYear
FFA Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Phone Number*
Alternate Phone Number
E-mail*
Working With Children
WWCC No.*
WWC Expiry*
Please upload a copy of your Play By The Rules Certificate*

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If you have not completed please go to https://www.playbytherules.net.au/online-courses/child-protection-online-course Cancelof
Please upload a copy of your Harassment & Discrimination Certificate*

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If you have not completed please go to https://www.playbytherules.net.au/online-courses/child-protection-online-course Cancelof
Current Coaching
Current Qualification*

FFA/AFC 'C' Licence - YouthFFA/AFC 'B' LicenceFFA/AFC 'A' LicenceFFA/AFC Pro DiplomaOther
Current Club Coaching*
Current Age Group Group*
Please attach coaching CV*

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Please upload copy of current ID/Drivers Licence*

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Team Preferences

Please list your three preferences for the Region and the age groups you wish to coach.

Please be advised that Coaches with Children participating in the State Titles will not be able to coach their child.
Do you have a child participating in the State Titles tournament?*
1st Preference Region*
1st Preference Age*
2nd Preference Region*
2nd Preference Age*
3rd Preference Region*
3rd Preference Age*
Reference/Referee

Please supply the details of two referees from your previous/current coaching experiences that FNSW may contact.

Referee #1
Name*
Position Held*
Club*
Contact Number*
Was the above referee your immediate supervisor?*
Referee #2
Name
Position Held
Club
Contact Number
Was the above referee your immediate supervisor?
Should be Empty:

Football NSW State Titles Coaching Expression of Interest