Indiana State University Athletics
Indiana State University Athletics NON-COACHING STAFF EMPLOYMENT QUESTIONNAIRE & CERTIFICATION (NCAA Bylaws 11.4 and 13.8, et seq) ADMINISTRATORS/HIRING AUTHORITY TAKE NOTE: In men's basketball only, during a two-year period before a prospective student-athlete's anticipated enrollment and a two-year period after the prospective student-athlete's actual enrollment, an institution shall not employ (or enter into a contract for future employment with) an individual associated with the prospective student athlete in any athletics department non-coaching staff position such as a manager, director of operations, strength coach, etc. Applicant Name
ISU Email Address
Athletic Department Non-Coaching Job/Position Applied For: 1. How did you learn of this job/position? 2. Is your potential employment within the athletic department conditioned upon the enrollment of any prospective student athlete in the sport of men's basketball?
Yes
No
3. Are you the parent, coach, relative, guardian of a prospective student athlete inthe sport of men's basketball or have any other type of association with any prospective student athlete in the sport of men's basketball?
Yes
No
4. List prior places of employment. Include all basketball-related activities (Attach separate sheet if needed) NOTE: If the answer to Question #3 above is "yes," please provide below specific information detailing what type of relationship you have with any prospective men's basketball student athlete including their name(s), affiliations, relationships, schools, teams and the specific dates of any type of association with said prospect(s). (Attach separate sheet if needed).
By signing below, Applicant certifies that to the best of his/her knowledge, the above responses are truthful and correct to the best of my knowledge. Furthermore, I understand that certain pre-existing relationships under NCAA regulations or unreported pre-existing relationships may cause the above named prospective student-athlete to become ineligible to participate in Intercollegiate Athletics at Indiana State University and that my potential and future employment within the athletic department is conditioned upon my answers above. Date
Applicant Signature
***Compliance Certification*** After reviewing the applicant's answers above and researching his/her employment and athletic background, under NCAA rules, I hereby certify that the applicant is a permissible candidate for any non-coaching staff position within the athletic department . Asstistant Athletic Director for Compliance
Distribution: Original-Employee file; Copies-Compliance; Applicant/Employee
Date
Rev 07/2013
ISU Email Address
Athletic Department Non-Coaching Job/Position Applied For: 1. How did you learn of this job/position? 2. Is your potential employment within the athletic department conditioned upon the enrollment of any prospective student athlete in the sport of men's basketball?
Yes
No
3. Are you the parent, coach, relative, guardian of a prospective student athlete inthe sport of men's basketball or have any other type of association with any prospective student athlete in the sport of men's basketball?
Yes
No
4. List prior places of employment. Include all basketball-related activities (Attach separate sheet if needed) NOTE: If the answer to Question #3 above is "yes," please provide below specific information detailing what type of relationship you have with any prospective men's basketball student athlete including their name(s), affiliations, relationships, schools, teams and the specific dates of any type of association with said prospect(s). (Attach separate sheet if needed).
By signing below, Applicant certifies that to the best of his/her knowledge, the above responses are truthful and correct to the best of my knowledge. Furthermore, I understand that certain pre-existing relationships under NCAA regulations or unreported pre-existing relationships may cause the above named prospective student-athlete to become ineligible to participate in Intercollegiate Athletics at Indiana State University and that my potential and future employment within the athletic department is conditioned upon my answers above. Date
Applicant Signature
***Compliance Certification*** After reviewing the applicant's answers above and researching his/her employment and athletic background, under NCAA rules, I hereby certify that the applicant is a permissible candidate for any non-coaching staff position within the athletic department . Asstistant Athletic Director for Compliance
Distribution: Original-Employee file; Copies-Compliance; Applicant/Employee
Date
Rev 07/2013
