Please email to vvbjulie@gmail.com or fax to 702-837-1329

Name______________________________________________________________       Date______________________

Address______________________________________________City____________ State________ Zip_____________

SSN #_____________________________________Date of Birth ____________________________________________

Home Phone_______________________________ Cell Phone______________________________________________

E-Mail ______________________________________        Spouses Name_____________________________

Employer________________________ Occupation______________________ Job Title__________________________

Address____________________________________________ Business Phone_________________________________

Would you or your place of employment be willing to sponsor a team?  ☐ Yes         ☐ No

 In which of the following would you like to participate? ☐ Manager (Head Coach)  ☐ Coach (Assistant)

MLB Team Name Preference:             1st choice – _______________________________________

 Team is NOT Guaranteed. MLB

  Hat Inventory will dictate                         2nd choice – _______________________________________

 availability.

                                                                       3rd choice – _______________________________________

Please check what division you are applying for.

List personal playing experience:   Little League, High School, College, and/or Pro:

_________________________________________________________________________________________________

Do you have any Manager/Coach Certifications? ☐ Yes     ☐ No,

If yes, list: ________________________________________________________________________________________

Have you managed or coached in VVB before?   ☐ Yes         ☐ No

If Yes, what division? _______________________________________________________________________________

List other coaching experience: _______________________________________________________________________

_________________________________________________________________________________________________

 Do you have children in the program?        ☐ Yes   ☐ No

If yes, children’s names and at what level(s)?

_____________________________________________________________

Why do you want to manage a VVB Team?

_________________________________________________________________________________________________

How will you motivate your team to do their best? _________________________________________________________

_________________________________________________________________________________________________

Will you allow players choices in the positions they play? ___________________________________________________

_________________________________________________________________________________________________

Do you have a valid driver’s license?   ☐ Yes           ☐ No        Driver’s License # ________________________State ______

 Have you ever been convicted of any crime(s)?          ☐ Yes       ☐ No    

If yes, explain_____________________________________________________________________________________

Have you ever been refused participation in any other youth programs?            ☐ Yes           ☐ No

If yes, explain: ____________________________________________________________________________________

________(Initial) RESPONSIBILITY TO RECRUIT PARENT VOLUNTEERS:   If I am selected as a Manager/Coach in VVB, I understand that it is my responsibility to recruit parent volunteers from my team as needed for fundraising and league events.

 ________(Initial) I will attend any and all mandatory meetings that are set up by the league.   Failure to attend without approval from the league could lead to dismissal of the position.

 _______   (Initial) If I am selected as a Manager, I will issue VVB a check for $300.00, which is returnable in full at the end of the season once all equipment has been returned.

 ______   (Initial) As a condition of volunteering, I authorize the Henderson Police Department to release information regarding any arrest, detention, field citation, field interview cards, officer’s records, jail/custody booking records, traffic citations and traffic accident information, district attorney records, court records and reports, probation and parole reports and records, and any other criminal justice records, reports or information about me.   I further understand that by my signature, I authorize VVB to conduct a background search as necessary.

I waive my rights under Title 5, United States coed Section 552A, the Privacy Act of 1974, with the understanding that only the VVB will use the information furnished.   This waiver and release applies to information covered by Title 5 as well as information not covered by that stature.  

I hereby release you, your organization and others from any liability or damage which may result from furnishing the information requested, including any liability pursuant to any state or local code or ordinance, or any similar laws.

______(Initial) I also understand that regardless of previous appointments, I may not be appointed to a volunteer position.   If appointed I understand that, prior to the expiration of my term, I may be subject to suspension by the President and removal by the Board of Directors.

I hereby apply for the position indicated above with VVB.   I also certify that the information given on this application is true and correct.  

Note: VVB does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference, or religious preference.

_______________________________________________________                         _____________________

Applicant Signature                                                                                                Date                                                                

  Note: a photocopy reproduction of this request shall be for all intents and purposes as valid as the original. You may retain this form in your files.