Volleyball Festival SM Staff App - 2021 Question Title * 1. Contact Information FOR PHONE PLEASE PROVIDE CELL PHONE NUMBER Name: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * OK Question Title * 2. T Shirt Size XS - Xtra Smal S - Small M - Medium L - Large XL - Xtra Large 2XL - 2 XL Other (please specify) OK Question Title * 3. Sweat shirt Size XS - Xtra Small S - Small M - Medium L - Large XL - Xtra Large 2XL - 2XL Other (please specify) OK Question Title * 4. Please select wheth.er you are an Athletic training Student (ATS) or an athletic trainer (ATC) Athletic Training student ATC OK Question Title * 5. If BOC Certified Please Provide BOC# OK Question Title * 6. Please provide State License Number (If Applicable) OK Question Title * 7. Do you have your own personal liability insurance policy? (Please note you are not required to have this but if you do please list. Students also please list if you have purchased your own student liability and it was not purchased through your school or program) Yes No Not Sure If Yes Please note with who and what coverage if you know 1mil/3mil other? OK Question Title * 8. If you are an Athletic Training Student will you be taking the BOC Exam Prior to the festival? Yes No OK Question Title * 9. If Athletic Training Student Please Provide Name of University you are attending? Please note it is preferred you are in a CAATE Accredited program? OK Question Title * 10. If an Athletic Training Student Please indicate which level of professional program MSAT BSAT OK Question Title * 11. Education: Please list your current education starting with Junior college to most current degree program enrolled Please list the Name of the School Dates you attended and the degree and Date conferred or Anticipated Bachelors Degree Masters Degree Doctoral Degree OK Question Title * 12. ATC's & Students Please upload a copy of your BLS / Professional Rescuer CPR Card Card . (you can take a picture with phone file types acceptable are PDF, PNG, JPG, JPEG) PDF, DOC, DOCX, PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File ATC's & Students Please upload a copy of your BLS / Professional Rescuer CPR Card Card . (you can take a picture with phone file types acceptable are PDF, PNG, JPG, JPEG) OK Question Title * 13. Students only Please upload a copy of your First Aid Card. Acceptable format PDF, PNG, JPG, JPEG PDF, DOC, DOCX, PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Students only Please upload a copy of your First Aid Card. Acceptable format PDF, PNG, JPG, JPEG OK Question Title * 14. Please provide at least 1 current and 2 previous employment positions in Athletic Training if an AT or if a student provide your three recent clinical experience rotations. Include Date from/ to Name of Organization/company or School, Position. Current Employment or Clinical Experience 1: Previous Employment or Cliincal Experience 2: Previous Employment or Clinical Experience 3: OK Question Title * 15. please list two references there name and phone number for each for AT's one must be from your current employer for AT students 1 should be from your most recent preceptor. Reference#1 Reference#2 OK Question Title * 16. If you have previous worked with the Volleyball Festival or Fiesta Classic please indicate the number you have worked enter a numerical number and (0) if you have not worked any previous. OK Question Title * 17. Will you need housing during the festival? Yes No OK Question Title * 18. Will you have a car with you (we need to know to provide for parking at venues or hotels) If you are flying in there is a light rail that provides transportation to downtown hotels or you can take a cab or shuttle service please not these transportation costs are not covered by the Volleyball Festival? Yes no OK Question Title * 19. Preferred work schedule, please note priority will be given to applicants that have availability for the entire tournament. We are assuming if you are applying that you are available for these times during the dates of the Volleyball Festival: June 26 thru July 3, 2021, with staff arriving on June 23 for orientation and training June 24 & 25, 2021 Please indicate by ranking your preference below 1 for your first choice and 2 for your second choice. Consideration will be given to try and accommodate however final schedules will be made to assure coverage for the tournament so all requests cannot be guaranteed. 1 2 Early Shift approximately 6 am to 4pm 1 2 Late Shift approximately 11 am to 11 pm or end of play as dictated by play OK Question Title * 20. Please provide your current email address:(yes this question is being asked a 2nd time to verify correct email address was submitted) OK Question Title * 21. The Volleyball Festival requires that you certify your application by submitting your typed electronic signature. To certify your application please read the text below and provide an electronic signature (type your name) and then submit your application. I certify that all the information on my application is accurate and true, I understand that lying on the application or falsifying any information my result in my not being hired or dissmissed as a member of the sports medicine staff. OK DONE