www.NIThunder.com
P.O. Box 408 Sugar Grove, IL 60554
Legal Name: ________________ __________ _____________________
First Middle Last
Permanent Address: _______________________________________
_______________________________________
Phone: (____) ____________
Date of Birth: ____-____-______
Social Security Number: _____-___-_____
Drivers License Number: ______________ DL State: ___ (if other than IL)
E-Mail: _________________@______________
What position are you applying for: Head Coach Assistant Coach
What team are you applying for: 12U 14U 16U 18U
Please provide us with two references that we can contact in regards to your coaching background:
1. Contact Name: _____________________ Phone Number: (___) ___________
2. Contact Name: _____________________ Phone Number: (___) ___________
I, ____________________________, do hereby grant permission for Northern Illinois Thunder, N.F.P. to conduct a criminal background check on myself. I understand that the State of Illinois Police will conduct my background check and all information will be kept confidential within the files of Northern Illinois Thunder, N.F.P. Advisory Board as required by the privacy act.
E-Mail (scan to pdf.format) completed form to: pclark45@sbcglobal.net