ATHLETIC COACH ASSIGNMENT RECOMMENDATION

ATHLETIC COACH ASSIGNMENT RECOMMENDATION
MT. DIABLO UNIFIED SCHOOL DISTRICT

1936 Carlotta Drive, Concord, California 94519-1397

Phone (925) 682-8000

Fax (925) 676-4092
Complete and submit this form and the Athletic Director will automatically receive an email to sign. Once the prospective coach and Athletic Director complete the Athletic Coaching Recommendation, the appropriate HR staff and you will receive a copy.

All coaches must complete paperwork and be fingerprinted. Coaching is not allowed until all paperwork, certificates and clearances are complete.
Legal Last Name*
Legal First Name*
Nickname
If Returning To MDUSD, Please Put Your Employee ID Number (If Known)
Email*
example@example.com
Cell Phone*
Home Phone
Address, City, State, Zip Code*
School Site*
Coaching Year*
Level*

VarsityJ.VFreshmanFROSH /SOPH
Season*
Sport*
Gender*
Recommended by (Athletic Director Name)*
Recommended by Email (Athletic Director)*
example@example.com
Recommended by Email (Athletic Director) 2
example@example.com
By signing below, I understand that I must:

1. Have a current First Aid Card and CPR Card. (Completed in person, or through red cross)

2. Must show a current (within 60 days) clear TB test. TB Assesment Form from your medical provider is accepted.

3. Complete the New Coach Packet

4. Complete ALL required courses

5. Complete and be Cleared through District & DOJ Fingerprint Process (Done at orientation)
Prospective Coach Signature *

Clear
Date*

MonthDayYear
Date
**BELOW INFORMATION WILL BE COMPLETED BY THE SCHOOL SITE**
Choose One In Regards to This Coach

New ProspectOnly Update RequiredVolunteer
Head or Assistant (Choose One)

HeadAssistant
Funding Source (Choose One)

District FundedSelf FundedGate Funded (FROSH)Volunteer
Phone/Ext
Recommenders (Athletic Director) Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

ATHLETIC COACH ASSIGNMENT RECOMMENDATION

**BELOW INFORMATION WILL BE COMPLETED BY THE SCHOOL SITE**

BELOW INFORMATION WILL BE COMPLETED BY THE SCHOOL SITE