Maine Lacrosse Officials Organization
Application
PLEASE print this form, complete it, then mail it to: Phil Anson, 81 Winnocks Road, Scarborough, Maine 04074

Full Name:

E-Mail:

Street Address1:
Street Address2:
City State:
Zip Code:

Home Phone:
Work Phone:
Mobile Phone:

Birthdate (not required):
Gender:


Please describe your experience, if any, with lacrosse (coaching, officiating, playing, etc).

 

Have you experience officiating other sports? If yes, list the sports and number of years

 

 

Have you experience coaching or teaching? If yes, explain

 

What is your time availability for officiating?

Weekdays:

Saturdays:

Please list 3 References (name, address, phone)
1.

2.

3.

 

How did you become interested in officiating lacrosse?

This section is mandated by the Maine Principals Association and is to be completed annually.

Have you ever been convicted of a felony or have felony charge pending? Yes or No. If Yes, please explain the nature of the conviction

Have you ever been convicted of a misdemeanor in the last 5 years Yes or No. If Yes, please explain. Do NOT include minor traffic violations

Are you legally able to work with school age children? Yes or No If No, please explain

Additional explanations (if necessary)

By siging this MLOA application form, you are validating the following statement: All answers and statements are true and complete to the best of my knowledge. I understand MLOA may verify information, and that false or misleading answers could be cause for rejection of this application or dismissal if a member.

Signature:

Date: