PALS Program/Sports School Student Staff Application 2018

Job description is posted at brocku.ca/recreation/student-employment

Position Applying For (Select One Only):

☐PALS & Sports School (approx. 4 months) ☐Sports School ONLY (approx. 2 months) Name: Student #: LOCAL ADDRESS (while at Brock) HOME ADDRESS (if different) Street: Street: City: City: Postal Code: Postal Code: Phone #: Phone #: Brock email: Home email: Academic Program: Estimated graduation year

List related teaching experiences (coaching, camps, YMCA, etc.) and volunteer experience:

List the activities you have participated in, number of years and level of play:

PALS Program/Sports School Student Staff Application 2018

Sport & Program Interests For each activity listed, please indicate your experience and level of comfort as it relates to the planning and teaching of the activity. N/A: I am not trained or experienced in this area. Novice: I have some experience and could help to teach this activity. Specialist: I have extensive experience and/or certification in this activity.

Sport/Activity N/A Novice Specialist Archery Badminton Baseball Basketball Co-op Games Creative Movement Educational Gymnastics Fencing Floor Hockey Football Golf Lacrosse Martial Arts (specify) Orienteering/Outdoor Ed. Rowing Rugby Soccer Squash/Racquetball Tennis Track & Field Ultimate Frisbee Volleyball Yoga Other (specify below):

For any you have identified as SPECIALIST, please provide a summary of your experience, training or level of competition for these activities or sports:

Sport/Activity Training, Experience, Certification, Level of Competition

PALS Program/Sports School Student Staff Application 2018

Will you be returning to Brock in the fall of 2018? Do you plan on taking any Spring/Summer courses? I give permission for the references I provided to be contacted Have you ever been convicted of any criminal offense in respect to which a pardon has not been granted under the Criminal Records Act and has not been revoked? If yes, please list offenses for which you have been convicted? Please read and sign the following statement: “I agree that misrepresentation of facts by me in this application shall be sufficient cause for dismissal if I am employed by Brock University.” Date (Day/Month/Year) Signature

Protecting Your Information Personal information is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) for the administration of the University and its programs and services. For details on the use and disclosure of this information call Brock Sports at (905) 688-5550, ext. 4060 or see brocku.ca/recreation-services

*Please attach a copy of your cover letter, current resumé and a copy of your Standard First Aid / CPR Certification and hand into the Walker Sports Complex Welcome Desk by February 2, 2018.