2019 Under 16 Basketball QLD State Team Coach Application

2019 Under 16 State Team Coach Application

Please complete the form below to apply for a position as a State Team coach for a 2019 Under 16 State Team
Personal Details
Full Name *

First Name Middle Name Last Name
Are you an Australian resident living in Queensland? *

Yes No

Phone Number *
Email Address *

Address

Street Address
Street Address Line 2
City/Suburb	State / Province
Postcode	Country

BQ Registered Coach

YES NO
Coach Accreditation Details
Current Coach Accreditation or license level *
Date of accreditation/license

- Month - Day Year
Date
Accreditation/license Renewal Date

- Month - Day Year
Date
Association where you are currently coaching and age group or level for 2018 (e.g. Rockhampton U18 state championship DIV 2) *

Please list any other programs or teams you are currently coaching as a HEAD Coach (extremely desirable for Head Coach positions relevant to this State Team Under 16 age group) (e.g. SBL Head Coach/QBL assistant coach, SPP Network Coach)
Please summarise your past experience at this level (i.e. Under 16 /or State/ or level above (SBL/QBL/SPP in terms of years, teams & programs and success as a HEAD COACH).
Please list and summarise your personal skills that make you a preferred candidate for the applied position?
Please succinctly summarise your key coach leadership and competition head coach attributes & experience that make you a most suitable candidate for this head coach/position?

References

Please provide details of two references:
Reference 1
Full Name *

First Name Last Name
Position
Phone Number *
Reference 2
Full Name *

First Name Last Name
Position
Phone Number *

State Team Application Details

Please detail the State Team coaching position/s you wish to apply for.
Which position/s that you are applying for *

Head Coach Assistant Coach Development Coach
In which Region do you wish to coach *

North Queensland South Queensland
Which gender/s do you wish to coach *

Female Male
Selection Criteria

Please upload your resume and ensure that it addresses the selection criteria set out in the Basketball Queensland Coach selection policy.
Upload Resume *

Conflicts of Interest

Applicants must declare if they have a "Conflict of Interest" with any of the players who are eligible for selection in the age group and gender in which they are making application.
Are you related to a player eligible for selection in the age group and gender in which the application is being made? *

Yes No
Please Note: A coach that is related to a player who is eligible for selection in the age group will not be selected.
Do you have a personal relationship (e.g. a personal friend of the family) with a player or players in the age group and gender in which the application is made? *

Yes No
Do you coach a representative team in the age group and gender in which the application is made? *

Yes No
If you have answered "Yes" to any of the conflict of interest questions please indicate how you would manage the conflict?

Blue Card

You MUST already have a Blue Card issued by the Commission for Children and Young People and Child Guardian signifying that the applicant can work with children under the age of 18.
Blue Card Number *
Member Protection Declaration

I wish to be appointed as a coach in the Basketball Queensland State and Emerging State Team Program and do solemnly declare that:

1. I have never been charged with any criminal offense relating to narcotics, violence or abuse including sexual abuse.

2. No person has ever sought or obtained any intervention order, injunction or other restraining order against me alleging dishonesty or verbal or physical abuse (including sexual abuse).

3. I am not currently the subject of any sanction issued by a basketball association against me which prohibits me from holding a position of the type set out in clause 1 above.

4. No application submitted on my behalf has been rejected for, nor have I been suspended or dismissed from, a position in sport, volunteer organisation, business, educational or other Government or semi-government organisation where that rejection, suspension or dismissal relates to my conduct with persons aged under eighteen (18) years of age or to violence, drug use or to dishonesty.

5. There are no other matters, which a reasonable person would consider relevant to the fitness of a person to be a coach of a team of players aged under eighteen or an administrator with frequent contact with persons aged under eighteen.

6. I also agree to uphold the acceptable standards of behaviour and conduct whilst acting in my role and are fully aware and accept that should any of these standards listed in the code of conduct be breached I will be dismissed from my role within this program and acknowledge that I will also be excluded from all future Basketball Queensland Development Programs at all levels.

7. I will notify the President or CEO of the organisations appointing me to my position immediately upon becoming aware that any of the matters set out in clauses 2 to 6 above has changed for whatever reason.

8. I make this declaration that the information contained in it is true and correct and I understand that a person making a false declaration is liable to the penalties of perjury.
*

I agree

Conditions of Appointment

1. I agree to abide by the terms and conditions (including the Coach’s Code of Ethics) contained in the State and Emerging Team Coach Selection Policy and that disciplinary action may be taken if I breach any of the terms and conditions set out in this policy.

2. I acknowledge that Basketball Queensland may take disciplinary action against me, if I breach the code of ethics. (I understand that Basketball Queensland are required to implement a complaints handling procedure in accordance with the principles of natural justice, in the event of an allegation against me)

3. I acknowledge that disciplinary action against me may include de-registration from the National Coaching Accreditation Scheme & all other Basketball Queensland Programs.
*

I agree and acknowledge

You must be a registered coach with a current accreditation/ license. For further information about how to become registered and/or accredited/licensed, please contact your association.
Do you acknowledge this?

Yes

You must be an Australian Resident living in Queensland to be eligible for selection as a Queensland State Team Coach.

Do you have any further comments that you would like to add?
Should be Empty:

2019 Under 16 State Team Coach Application

Blue Card