APPLICATION FORM FOR HOUSE/LOCAL LEAGUE & DIVISION COACHES, TRAINERS AND STAFF (Port Colborne Minor Hockey)

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Print APPLICATION FORM FOR HOUSE/LOCAL LEAGUE & DIVISION COACHES, TRAINERS AND STAFF

Please fill in all areas needed and submit your Information Sheet.

APPLICATION FORM FOR HOUSE/LOCAL LEAGUE & DIVISION
COACHES, TRAINERS AND STAFF

Please read the following information below to have an understanding of what is expected from all PCMHA volunteers.

As a PCMHA Volunteer, I will...

1. Familiarize myself with, and abide by, the policies of the Port Colborne Minor Hockey Association (PCMHA).
2. Upgrade my credentials as needed for the volunteer position within PCMHA.
3. Attend all Coaches meetings scheduled by the PCMHA.
4. Comply with the Constitutions, Code of Ethics, and Fair Play Codes of the Port Colborne Minor Hockey Association (PCMHA), the Ontario Minor Hockey Association (OMHA), & the Niagara District Local League (NDLL) documents.
5. Familiarize myself with the omha.net website for coaching and trainers resources.
6. I understand that any proposed Bench Staff must be listed on this application and submit their own application as well.
7. I am aware that this application will trigger an interview with myself and members of the coach selection committee prior to being assigned a team.
8. I understand that all volunteers will be subject to a Vulnerable Police Sector Check. If you have a Vulnerable Police Sector Check that is less than three(3) years old, it must be on file with PCMHA. If your Vulnerable Police Sector Check is more than three(3) years old, you will be required to obtain a new one.

In order to proceed you must check the "I agree to the information stated above" button,

If you require a copy of any of the above mentioned documentation, policies, they can all be found on the PCMHA website

I agree to all the information stated above*^*
SPECIAL REQUIREMENT TO ALL PCMHA HOUSE LEAGUE AND LOCAL LEAGUE VOLUNTEERS

All volunteers applying for any position with PCMHA are required to have a Vulnerable Sector Background Clearance Certificate (Police Background Check)

In order for this information sheet to be submitted, you must reply to all the questions within this Information Sheet.

If you have any questions or problems, please feel free to contact Randy Huggins [email protected] or Matt Lallouet [email protected]

PERSONAL INFORMATION

Please provide all pertinent information for Head Coach, Assistant Coach, Trainers, Manager and On Ice Helpers

Name^*

First and Last Name

Date of Birth^*

Open the calendar popup.

Address^*
City^*
Home Phone^*

Example: ###-###-####
Cell Phone

Example: ###-###-####
Email 1^*

Example: [email protected] Your submission will be sent to this address.
Email 2

Example: [email protected]
Will the demands of your job interfere with your availabilty to be a reliable staff member?^*
YesNo
If Yes above, provide details

VULNERABLE SECTOR BACKGROUND POLICE RECORD CHECK

Please provide a copy of your Vulnerable Sector Background Check here. If PCMHA does not have it on file

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.
Maximum # Files: 1. Maximum File Size: 4MB.

CRIMINAL OFFENSE DECLARATION

If you have submitted a Vulnerable Sector Background Police Record Check to PCMHA within the last 3 years, please answer Yes or No on this Declaration Page, If nothing has changed, we will verify your information with our records.

Do you have any convictions for offenses under the Criminal Code of Canada as outlined in the OMHA Police Record Check Policy, up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada)^*
NOYES
If you answered "Yes" to the above question, please provide details

COACHING CREDENTIALS: Please tell us what level of training you have completed.

COACHING QUALIFICATION LEGEND: 1. Coaches of House League/Local League/ Minor Development / Rostered Select in divisions below Novice (Initiation & Tyke) must hold Coach 1-Intro to Coach qualification - No other qualifications are accepted 2. Coach 2-Coach Level ‘Trained’ or higher: Coach 2-Coach Level ‘Trained’ or ‘Certified’; Development 1 ‘Trained’ or ‘Certified’; High Performance 1 & 2 ‘Trained’ or ‘Certified’ 3. Development 1 ‘Trained’ or higher: Development 1 ‘Trained’ or ‘Certified’ or; High Performance 1 & 2 ‘Trained’ or ‘Certified’ 4. Development 1 ‘Certified’ or higher: Development 1 ‘Certified’ or; High Performance 1 & 2 ‘Trained’ or ‘Certified’ 5. High Performance 1 ‘Certified’ or higher: High Performance 1 & 2 ‘Certified’

OMHA Coaching Level^*

Choose Level
OMHA Trainers Level^*

Choose Level
Respect in Sport (RiS) Activity Leader Program^*

Completed or In Progress
Respect in Sport (RiS) Parent Program^*

Completed or In Progress
Gender Identity and Expression Course^*

Completed or In Progress
Are You Registered For Any Future Clinics? If so please include the place, date, and type of clinic.

TEAM REQUESTED

Team / Division Choice^*
U5
U7
U8
U9
U11
U13
U15
U18
U9 REP
U11 REP
U13 REP
U15 REP
U18 REP
Position Applied For^*
Head CoachAsst CoachTrainerManager
Do you have a child that will be playing in this division?^*
YESNOUnsure
Do you have any PROPOSED team staff members? If so, be aware that all team staff members MUST also submit an Information Sheet separately; as well, all proposed team staff are also subject to a police check and PCMHA Board approval.
Will any of the team staff listed above potentially have children on this team?
YESNOUnsure
Only complete if you filled out any of the proposed team staff above
If this position is not available, would you accept a different position?
YesNot Interested
Check All That Apply
If you are applying as a member of a coaching staff, please provide the name of the Coach

COACHING EXPERIENCE

Please provide detailed information of your personal coaching experience

Please list all Relevant Experience. And Supply 2 references PCMHA can contact.^*

Please include Centre / Age&Level / Year / Sport / Position of any prior experience and the names and contact info of two references

Human Validation

Check The Box ^*