Waverley Victory Football Club Season 2017

Coach - Expression of interest

Applicants Details
Title
Name
Surname
Email Address
Mobile No.

Alternate No.

Postal Address

Post Code

Registration Details

Registration Details (must have or be in the act of acquiring)

FFA registration Number

Coaching ID number

(Usually a 8 digit number)

(Usually a 7 digit number)

Working With Children Check (WWCC)

This is a mandatory requirement for all coaching positions at WVFC. An applicant must provide a photocopy
of the card. We have a legal obligation and duty of care, not only to protect our children, but ourselves as
we undertake these positions of great responsibility.
Expiry
date:

Card number

(Usually a 10 digit number)

Note: Please attach a copy of your WWCC to the back of this submission.

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Waverley Victory Football Club Season 2017

Coach - Expression of interest

Qualifications
Community Pathway

Year
obtained

Qualifications
Advanced Pathway

Grass roots

ACC C-Licence (pre 2014)

Junior Licence (pre 2014)

ACC B-Licence (pre 2014)

Youth Certificate 1 (pre 2014)

ACC A-Licence (pre 2014)

Youth Certificate 2 (pre 2014)

ACC Pro- diploma (pre 2014)

Senior Certificate 1 (pre 2014)

FFA/AFC C-Licence, part 1

Senior Certificate 2 (pre 2014)

FFA/AFC C-Licence (Youth)

Skill Training Certificate

FFA/AFC C-Licence (Senior)

Game Training Certificate

FFA/AFC B-Licence

Senior Coaching Certificate

FFA/AFC A-Licence

Goal Keeping Certificate

FFA/AFC Pro- diploma

Goal Keeping Licence

Goal Keeping Licence, Level 1

Goal Keeping Diploma

Goal Keeping Licence, Level 2

Futsal Certificate

Goal Keeping Licence, Level 3

Futsal Licence

Futsal Licence, Level 1

Futsal Licence, Level 2

Others (Overseas Qualifications considered)

Last Coaching Role

Experience
Year you last Coached:
Did you coach at WVFC?

yes
no

Did you coach at another Club?

yes
no

Team (age group and level):

Club:
Team (age group and level):

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Year
obtained

Waverley Victory Football Club Season 2017

Coach - Expression of interest

While we cannot always guarantee which team you will be allocated we will endeavour to meet
your request.
Preferred
Age group

does not matter

coach my childs team

SSF Joey
SSF Wallaby
SSF Kangaroo
Child 1

Will you have a child(ren) at

WVFC (next year)

yes
no

A
B
C or D
Child 2

Child 3

Age group(s):

By signing this application, I have express an interest in a coaching position with

Waverley Victory FC for the nominated season and confirm, should I be offered
a coaching position with the club, that I will agree to undertake any training that
the club deems fit to help me in the execution of my duties as a coach wherever
possible.
I also confirm that I have read and understand the code of conduct set down by
Football Federation of Victoria and the Club and agree to abide by them.
I also confirm that all information provided on this application is true and
accurate at the time of submission.
I also confirm that I have a current and valid Working with Children Check
before accepting a coaching role with WVFC.

Signature of Coach

Date

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