Date Submitted_________________
| NAME | ________________________________ |
| (Last, First, Middle) |
| ADDRESS | ________________________________________________ |
| (Street, City, State, Zip Code) |
TELEPHONE ______________ DATE OF BIRTH _____/_____/_____ GRADE ________
In which Career Area are your major interests at this time? (circle one)
Arts & Communications Business & Marketing Health Human Services
Manufacturing & Industrial Technology Science Technology & Natural Sciences
Which specific job or career within that cluster do you find most interesting?
First Choice ________________________ Second Choice ________________________
Have you ever participated in a job shadowing experience in the past? YES NO
When? __________________ Where? ________________________
Explain why you would like to do a job shadowing experience and what you hope to gain from this opportunity?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do you have someone you would like to do a job shadowing experience with? (Please list.)
Person to Contact ________________________ Telephone __________________
Name of Business ________________________ Address ______________________________
Work Experience (List most recent job first.)
| Name of Company | Duties You Performed |
|---|---|
List any extracurricular activities in which you participate (school & community).
____________________________________________________________________________________
____________________________________________________________________________________
List any type of volunteer work activities which you feel will allow you to attain your career goals.
____________________________________________________________________________________
____________________________________________________________________________________
Do you have any special concerns or requests?
____________________________________________________________________________________
____________________________________________________________________________________
When would your school and/or work schedule best allow you to be away?
____________________________________________________________________________________
I understand the School District assumes no responsibility for health, accident, or transportation insurance while job shadowing. I agree to provide (or arrange) transportation to and from the job shadowing site.
| ____________________________ Signature of Applicant |
____________________________ Signature of Parent/Guardian |
|
| Date ____________ | Date ____________ |