2022 Regional TSP Coaching Expression of Interest Personal DetailsName* First Last Date of Birth* Date Format: 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 IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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*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*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 ClubCurrent Age Group CoachingEmployment EligibilityAre you eligible for employment in Australia?*YesNoIf no, please explain your visa type and entitlement to work?TSP CentreTSP CentreOrangeBathurstDubboNowraBowralMoruyaAlburyGriffithWaggaRefereeName of Referee #1 First Last Position Held*Club/Company*Contact Number*Was the Above Referee Your Immediate Supervisor*YesNoCoaching CV / ResumeUpload Coaching CV*Identification / Drivers LicenceUpload copy of current ID/Drivers Licence*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 boostersI have a medical condition preventing me from being vaccinated Δ