Personal and confidential
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- Football Officiating Application PERSONAL AND CONFIDENTIAL
- OFFICIATING BACKGROUND
- I acknowledge that the above information is correct and true.
- Coordinator of Football Officials Atlantic Coast Conference PO Drawer ACC Greensboro, NC 27417
A tlantic Coast Conference
Football Officiating Application PERSONAL AND CONFIDENTIAL Name _______________________________________________________ Date __________________ Home Address _______________________________________________________________________ City _____________________________________ State _______ Zip ___________________ Business Address _____________________________________________________________________ City _____________________________________ State _______ Zip ___________________ Telephone: Home _____________________________ Business _____________________________ Cell _______________________________ Email ____________________________________________ Profession or Occupation ________________________________________________________________ DOB _______________ Height ______ Weight _______ Social Security # ________________________ EDUCATION Graduate of High School _______________ College _______________ Post-Graduate _______________ Name of High School _______________________________ City _____________________ State ______ Name of College ___________________________________ City _____________________ State ______ Playing Experience in Years: Football H.S. _______ College _______ Other _______ Basketball H.S. _______ College _______ Other _______ ___________ H.S. _______ College _______ Other _______ (Specify Other) OFFICIATING BACKGROUND (NOTE: 5 years of high school and 5 years of college officiating (at any level) is required to be eligible for consideration on any roster) Number of years you have worked as an official: H.S. _______ College ________ Pro _______ Do you work, or have you worked, in other collegiate athletic conferences? Yes _______ No ______ If yes, which conference or conferences and when? _______________________________________ _________________________________________________________________________________ Do you officiate high school sports? Yes _____ No _____ Which sports? ______________________ What officials associations are you a member of? _________________________________________ _________________________________________________________________________________ In which capacity do you prefer to work football? 1-Referee, 2-Umpire, 3-Linesman, 4-Line Judge, 5-Field Judge, 6-Back Judge, 7-Side Judge? Please rank in order of preference: __________________________________________________________________________________ Are there any circumstances or conditions that affect your priority for accepting assignments to work in the Atlantic Coast Conference? Yes _____ No _____. If yes, please indicate. __________________
If yes, please describe the participation, name of club, etc. ___________________________________ __________________________________________________________________________________
Please list the names, addresses and phone numbers of three qualified persons who have observed your work as an official. These people may be contacted as references. 1. ________________________________________________________________________________ 2. ________________________________________________________________________________ 3. ________________________________________________________________________________
Signature: ___________________________________________________________________________ Please sign and return the completed questionnaire to: Doug Rhoads ATTN: ACC Football Officiating Application Coordinator of Football Officials Atlantic Coast Conference PO Drawer ACC Greensboro, NC 27417 Directory: Groups -> 104720 -> Library -> Files Groups -> Tiger Leaps Progress Update from Tenafly High School March 28, 2012 English Groups -> Personal Data: Name : Prasanna. S educational Qualification Groups -> Traffic alert and Collision Avoidance System or tcas Groups -> 1980s Type Card Master List from Standard Catalog 1980 Burger King Phillies Groups -> Lima Site 85 Personnel List Groups -> General knowledge Groups -> Kenneth pomeranz the great himalayan watershed Groups -> Christina Maria Bergqvist Files -> Atlantic coast conference summer clinic Download 38.34 Kb. Share with your friends:
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