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Winter 2000 - 2001 Availability Questionnaire

Availability Questionnaire

Winter 2000 - 2001 Season

Please complete and submit prior to November 11, 2000.

Referee Name

E-mail Address

Social Security Number (ex. xxx-xx-xxxx)

Date of Birth (ex. 01/01/1950)

Phone Numbers:

Experience: I a current USSF certified referee. I attained my current grade of on . Recertification last completed on . I have been a VHSL certified referee since Spring, .

I am generally available on the following days and times. Times are kickoffs at Richmond area fields
Monday
3:30
 4:00
Tuesday
3:30
 4:00
Wednesday 3:30 4:00
Thursday 3:30 4:00
Friday 3:30 4:00
(select all that apply).

I can leave from the following location at (ex. 17:00) on weekdays.

I would like to work matches on days most weeks.

Other assignment desires include

I have a personal conflict (attendance, previous attendance, relative, etc.) with the following: .

I am available and would like to work on the following match dates that I have checked. I have checked the time I could arrive at a Richmond area field on these dates. (St. Margaret's in Tappahannock is out of area.)

Monday
Tuesday
Wednesday
Thursday
Friday

11/13

11/14
11/15
11/16
11/17
11/20
11/21
11/22
11/27
11/28
11/29
11/30
12/1
12/4
12/5
12/6
12/7
12/8
12/11
12/12
12/13
12/14
12/15
1/2
1/3
1/4
1/5
1/8
1/9
1/10
1/11
1/12
1/15
1/16
1/17
1/18
1/19
1/22
1/23
1/24
1/25
1/26
1/29
1/30
1/31
2/1
2/2
2/5
2/6
2/7
2/8
2/9

You may wish to print a copy of the table above prior to submitting. You will NOT get a return copy of this information.