Coach Expression of Interest Form

Name (as per drivers license)*

First Last

Phone*

Email*

Drivers License Number*

Working With Children's Check Number*

For Example WWCXXXXXXX

Date of Birth*

Address (as per your drivers license)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Have you previously coaches a Rebels or Crusaders team?*

Yes
No

Coach Accreditation Level*

Is your Accreditation currently up to date (active)?*

Are you a registered member of Basketball NSW?*

Position*

Select All
Head Coach
Assistant Coach

First Preference*

Second Preference*

Third Preference

If you were unsuccessful in gaining a Head Coaching position, would you be willing to be considered for an Assistant Coaching Position?*

Please summarise your past Head Coaching experience at the level or above for which you have applied (in terms of years, teams & programs)*

What are your key personal & coaching attributes that you believe make you a suitable candidate for this head coach position?*

Conflict of Interest*

Are you related to a player eligible for selection in the age group and gender in which the application is being made?

Conflict of Interest*

Do you have a personal relationship (e.g. a personal friend of the family) with an athlete or athletes in the age group and gender in which the application is made?

Conflict of Interest*

Do you have a basketball related business involving personal coaching?

If you have answered "Yes" to any of the conflict of interest questions please indicate how you would manage the conflict?*

Are You Prepared To Facilitate 2 Training Sessions Per Week?*

Do You Agree To Adhere to the Coaches Code of Conduct*

Available on our website https://bistadium.com.au/policies-procedures/

Please provide the name of a coach who may be a reference for you (and who we may contact if necessary)*

Please provide a contact mobile number for the coach listed above*