This is the application for individuals wanting to apply for the men's and women's coaching positions for the FSM National Basketball Teams for the 2007 Pacific Games in Samoa.

If you have any questions, contact the FSM Basketball Federation by emailing: cgchuuk2@mail.fm

You may also contact the FSMBF representative nearest you.

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FSM BASKETBALL FEDEDERATION (FSMBF)
COACHES APPLICATION FORM

APPLYING FOR: MEN'S TEAM _____ WOMEN'S TEAM ____

YOUR NAME:

YOUR POSTAL ADDRESS:

YOUR PHONE NO: at home at work

Your Email address:
Your coaching accreditation details:
(example - OBC level 1 coach, PNG level 2 coach)

Year of accreditations:

Other sports accreditations:
Your coaching history: (list teams/competitions coaches during the past 5 years):

List coaching and sports courses, clinics, seminars, workshops etc attended during the past 5 years:


List any further detail that may assist your application:



Lifestyle Information
I smoke: Yes_____ No_____

I drink Yes_____ No_____
If you answered yes, Do you have a drinking problem? Yes_____ No_____

I use illegal substances Yes_____ No_____

I have read the outline of the FSMBF and understand its direction. I have also read and understand the job description and responsibilities of the position applied for. If selected I agree to abide by the direction of the FSMBF and the responsibilities of the position.

Please provide and attach your resume to this application form.


Your signature:

Date:
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