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Director of Tennis

Personal Information

Name
Prefix
First
Last
Suffix
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Date of Birth *

DD		/
MM		/
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Phone Number *
Email *

Previous Coaching Experience

Previous Relevant Sporting Qualifications
Please indicate your current level of coaching qualification with Tennis Ireland (if applicable)
 None 
 Play and Stay Assistant 
 Level 1 
 Level 2 
 Level 3 
 Other 
Have you ever been asked to leave a sporting organisation (If 'yes' please details below) *
Please give details, including dates, of any previous experience that you had working with children in a voluntary or professional capacity *
Please give details of any previous Tennis Ireland courses that you may have attended in the past

Please give names and addresses of two responsible people whom we can contact and who from personal knowledge, are willing to endorse your application (referees cannot be relatives of the applicant). If you had a previous involvement in sport one of these names should be that of an administrator or leader in your club or place of work

Referee One

Name *
Prefix
First *
Last *
Suffix
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone
Position *

Referee Two

Name *
Prefix
First *
Last *
Suffix
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone *
Position *

Do you agree to abide by the Guidelines contained in the Tennis Ireland Protection and Good Practice Guidelines 2005, available at http://www.tennisireland.ie/clubs/child_protection and by the Tennis Ireland Coaches Code of Conduct
 Yes 
 No 

I declare that all answers are complete and to the best of my knowledge
*
 Yes 
 No 
Signed *
Date Time *

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MM		/
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