Name *

First Name

Last Name

Phone *

(###)

###

####

What would you like to do at CEG? *

Preschool Coach

Recreational Coach

Team Coach

Special Events

Front Desk

Other

Preferred Start Date

MM

DD

YYYY

Have you ever been convicted of a felony? *

No

Yes

Have you ever been convicted of any crime involving the sale of drugs? *

No

Yes

Have you ever been convicted of any crime involving a sex offence? *

No

Yes

Have you ever been convicted of any crime involving physical violence against another person? *

No

Yes