April 22 2019 Referee Availability Form Form Submission NumberThis form should be used to submit your availability for all competitions you wish to officiate in for season 2022/23 for leagues and competitions FA sanctioned within the West Riding County FA. Please Note : The third weekend of the month is District FA conference dates. It is a West Riding County FA mandate on District Cup competitions to close any dates with your regular League/Competition when accepting an appointment. This will be administered online by leedsfa.pitchsiderefs.co.uk password is by FAN number once your form is received and details entered exclusive to the Leeds & District Football Association. Fields marked * are mandatory fields.Referee Contact DetailsFull Name*This should be your FIRST NAME and SURNAME Email Address*This is the default email address that will be used to communicate with you. Phone Number*This number will be used to communicate with you.Referees FA Number* Referee Age Range* Under 25 Age 25-45 Age 45-65 Over 65 Referee Level*Level 0Level 1Level 2aLevel 2bLevel 3Level 4Level 5Level 6Level 7Youth Registered RefereeTrainingDeveloperMini Soccer OnlyClub Only Home AppointmentsDo you have a current CRC ?*The FA requires those working in eligible* roles with children and young people to pass a criminal records check. Yes No Do you have a current Safeguarding Children Certificate ?*The FA requires those working in eligible* roles with children and young people to hold a current Safeguarding Children Certificate. Yes No Number of Years as Referee ?Move the slider to indicate the number of years you have been a referee.If you have refereed for 2 years or less, do you require a mentor?* Yes No Are you applying for promotion in the coming season?* Yes No Are you a member of the Leeds Referee's Association (Leeds RA)?* Yes No Do you have private transport?* Yes No Maximum distance you wish to travel (radius in miles) ?Move the slider to indicate the maximum number of miles you are prepared to travel.Which League/Competitions do you normally officiate in or intend to for 2022/23 season ?*Select the league/s you will be applying to officiate in for 2022/23 Season. Click on the down arrow to display a list of leagues. Click and select league. Click on the Add icon to select more than one league. Which Leeds & District FA Competitions would you like to officiate in?* Select All Open-Age Saturday (2pm / 3pm) Open-Age Sunday (11am) Juniors Sunday (2pm) Are you available for West Riding County FA Cup competitions if required on County FA Conference dates ?* Yes No Are you available for University midweek afternoon fixtures?* Yes No Are you available for end-of-season midweek fixtures?* Yes No Please confirm that you agree with the Leeds FA GDPR policy*View the Leeds FA GDPR Policy Yes Δ More