Example: [email protected]
Have you ever been convicted of a crime for which a pardon has not been granted?
If Yes, please describe below for each conviction:
Are criminal charges or any other sanctions, including those from a sport body, private tribunal or government agency, currently pending or threatened against you?
If Yes, please explain for each pending charge:
Has any civil court made a finding, judgement or ruling against you, or have you entered into an out of court settlement relevant to the profession of coaching, the sport of baseball or any other sport?
If yes, please describe each finding, judgement or ruling below:
Have you ever been the subject of a decision of a court or tribunal that might reflect adversely on the profession of coaching, the sport of baseball, or any other sport?
If yes, please describe below:
Have you ever been dismissed from a position due to allegations of ethical or moral misconduct?
Have you ever been disciplined or sanctioned by an international sport tribunal, by a National sport governing body outside Canada, by a National Sport Organization within Canada, or by any other sport organization?
For more than one conviction please attach additional page(s) as necessary.
Please identify which question the addition pertains to, and answer all follow up questions:
I herby certify that the information contained in this application is accurate, correct, truthful and complete. I further certify that I will immediately inform the Organization of any changes in circumstances that would alter my original responses to this Screening Disclosure Form. Failure to do so may result in termination of membership and/or further discipline.
Type your full name