Returning CORE 5 Official New CORE 5 Official Transfer Official With Exp. Observer / Evaluator
Game Officials Registration Form
Step 1: Biographical Information Last Name
Flag Football Season Year
Check Box That Is Applicable:
2016
First Name
Mailing Address
City & Postal Code
E-Mail Address
Home Phone Number
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Date of Birth dd/mm/year
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Cell Phone Number
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Social Security Number (last 4 digits)
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LEVEL
POSITION
YEARS EXP
Step 3: Criminal Background Disclaimer Verification CORE 5 Flag Football requires all officials to undergo a Criminal Background Check.
a) b)
Have you ever been convicted of a felony? Yes No
Step 5: Information Certification & Registration By completing this registration form as a contest official, I understand that I am eligible to officiate at the appropriate level of competition indicated by my experience, but fully understand that there are no assurances of any game assignments. Further, I understand that my officiating is based on my successful completion and passing of a Background Check. I also understand that I must be a certified member of USA Football. My officiating with the CORE 5 Flag Football does not create an employment contract as I am an Independent contractor and thus responsible solely for all expenses, fees and taxes. I will abide by all rules and policies of the CORE 5 Flag Football and will hold harmless their officers and representatives regarding all issues related to my duties and responsibilities as a contest official. I attest all information provided is truthful and accurate.
Non Refundable Background Check Fee of $10 must accompany your application. Make Checks Payable To: CORE 5 Flag Football
Have you ever been convicted of any crime, including sex-related or childabuse related offenses? Yes
c)
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SSN is for submission of background check verification purposes only
Step 2: Affiliated Game Experience Flag Football Youth Football Jr. High / Middle School Junior Varsity HS Varsity HS Minor League Collegiate Indoor
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No
Have you ever had your membership with any other officials association canceled, suspended or revoked? Yes No
Your Signature Date Submitted
Step 4 – Conflict of Interest Please list any team that you may have an affiliation with, including any relative, co-worker or child that may coach, play or have an interest in any team participating in the CORE 5 Flag Football where a conflict of interest may arise. _________________________________________________________________________________________________________
Turn this form in to your local CORE 5 Flag Football League Commissioner