Yes: No: Yes: No

Report 0 Downloads 15 Views

Futhermore, I understand that the Board of Directors can use my driver's license number and social security number to perform an NCIC background check.

OFFICIALS APPLICATION

First Name:

Last Name:

Address: Home Phone: __

City: __-__ __-_

Email Address: ______

___ Work Phone: __

State: __-__

Zip Code: __-_

__________________ Occupation: _____

Affiliated Game Experience: Please check all that apply Level Position □Flag Football □Youth Football □Jr. High / Middle School □Junior Varsity HS □Varsity HS □Minor League □Collegiate

___ Cell: __

__-__ __-_

___

_______________

Years Experience

Have you ever had your membership with any other officials association canceled, suspended or revoked? Yes: □ No: □ 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 SYFA where a conflict of interest may arise. If so, which team? __________________ _ Division: _ ______ Did you officiate at SYFA last year? Yes: □ No: □ Are you certified? Yes: □ No: □ If yes, is your membership current? Yes: □ No: □ Date of Issue: _____________ Exp Date: _____________ Are you currently under indictment? Yes: □ No: □ Have you ever been convicted of a felony? Yes: □ No: □ Have you used, or are you using any illegal drug(s)? Yes: □ No: □

If you answered yes to any of the three previous questions, please explain:

By filling out this application, I understand that it does not guarantee that I will be an official for SYFA. Futhermore, I understand that the Board of Directors can use my driver’s license number and social security number to perform an NCIC background check. If I am selected to officiate at SYFA, I agree to conduct myself in a manner specified in the rules and by-laws of the organization. I also certify that all the information included in this application is true and correct as of this current date. I accept: ___________________

___ I decline: ___________

__________

Date of Birth: ________________ Driver’s License Number: ______________ State Issued: ___________ Social Security Number: __

__-__

Signature of Applicant: ___

__-_ ___

____________________ Date: ___________________

S.Y.F.A. Use ONLY Approved: □ Denied: □ Signature of SYFA Officer:

________________

____ Date: ___________

Recommend Documents
Initial Per-Student Revenue. 16. Initial Per-Student Foundation Funding Amount. 17. Initial Per-Student State Foundation Funding Aid. 18. PY ALE FTEs (Qtrs.

Jul 31, 2015 - DATA. 1. 2014 Real Assessment. 2. 2014 Personal Assessment. 3. 2014 Utility Assessment. 4. 2014 Total Assessment. 5. 98% of URT X ...

Select a transcendent source, like. NCLIVE. Is it an electronic resource? For all of. NC. Cardinal? Import or update bib record. Add 856: indicators. 4 + 0, $u link, ...

Overall payment is less in the long run. Is your current cash flow needed to support day-to-day business operations? YES. NO. Will this property be right for.

Dec 21, 2017 - Please print or type all information - Application must be postmarked on or before March 1, 2018. ... this application and be responsible for my own costs incurred for transportation, housing, meals, uniform, and personal entertainment

Yes No. If yes, have medication forms been completed? Yes No. Additional information for the caregivers to know about your child's daily requirements or routine ...

May 30, 2017 - Name of Contact Person. Phone Number. Address: (Street, City, State, Zip) ... The University of Akron. Compliance Office for Athletics. Donation ...

Jan 17, 2017 - CELL PHONE. HOME PHONE ... Please indicate the top five areas that you prefer to officiate? ... and a contract between the Parties and me.

Standard: I can understand the meaning of equivalent expressions. Look at each expression. Is it equivalent to x + 3y. 2 ? Select Yes or No for expressions A–D.

10.50. $. RED Vintage Gem & Frosted Brads. 1.75. $. VP-8208. 10.50. $. VP-8207. 10.50. $. VP-8206. 10.50. $. VP-8205. 10.50. $. VP-8204. 10.50. $. VP-8203.