2022 Regional TSP Coaching Expression of Interest Personal DetailsName* First Last Date of Birth* DD slash MM slash YYYY Phone*Email* Uniform Size*SmallMediumLargeX LargeXX LargeApparel is KappaAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Working With ChildrenFFA No.* WWCC No.* WWCC Expiry* Upload a copy of your Play By The Rules Child Protection Certificate*Max. file size: 15 MB.Courses must have been completed in 2020 or 2021. If you need to complete the Course, please go to https://elearning.sportintegrity.gov.au/login/index.phpUpload a copy of your Play By The Rules Harassment and Discrimination Certificate*Max. file size: 15 MB.Courses must have been completed in 2020 or 2021. If you need to complete the Course, please go to https://elearning.sportintegrity.gov.au/login/index.phpCurrent CoachingCoaching Qualifications*Community Coaching LicenseLicense CLicense BLicense ACurrent Club Current Age Group Coaching Employment EligibilityAre you eligible for employment in Australia?*YesNoIf no, please explain your visa type and entitlement to work?TSP CentreTSP Centre Orange Bathurst Dubbo Nowra Bowral Moruya Albury Griffith Wagga RefereeName of Referee #1 First Last Position Held* Club/Company* Contact Number*Was the Above Referee Your Immediate Supervisor*YesNoCoaching CV / ResumeUpload Coaching CV*Max. file size: 15 MB.Identification / Drivers LicenceUpload copy of current ID/Drivers Licence*Max. file size: 15 MB.Declaration* I declare that the above information provided is true, complete and correct. I will notify Football NSW of any changes to the above information. Why should you be considered for the role?*Covid-19 Vaccination StatusIt is a condition of Employment that Employees are fully vaccinated against COVID-19 and that Employees agree to produce to Football NSW evidence of the same.Please indicate your Vaccination Status* I am double vaccinated and intend to have any other required vaccinations and/or boosters I have a medical condition preventing me from being vaccinated Δ