Personal Information

Name
 

Home Address
 

City
 

State
 

Zip
 

Phone
 

Work Phone
 

Cell Phone
 

Email
 

Birthdate
 

Place of Employment
 

Education Background:
Enter Educational Background Here.

Are you a United States Citizen? Yes No

Criminal Background:
Have you ever been convicted of a felony (yes/no) if so explain:

Hockey Information

Have you ever coached before and if so where and how many years per team:

Do you have any USA Hockey Coaching Certifications (yes/no) what level?

What do you feel are your strength as a coach?

What do you feel are your weaknesses as a coach?

What do you feel you can bring to Cal U Hockey Organization?

What are your short and long term goals for this program?

Do you have any experience in recruiting, off ice duties (General Manager), or any other training pertaining to the operations of a hockey club?

Do you have any schedule restrictions that may affect your availability to perform your job responsibilities (evening & weekends)?

Agreement

I 

certify that the above information is correct and answered to the best of my ability. I understand that I am not guaranteed this job and understand that California University of Pennsylvania has the right to request a criminal
check at anytime. I also understand that should I receive this position that I must also sign a contract with the following organizations: Student Association Incorporated California University of Pennsylvania and the Hockey Club of California University of Pennsylvania.