Cooperative Application Form

Co-op Application Form

To be eligible, for co-op students must have the recommendation of their technical program teachers, and meet the required grade, attendance, and discipline standards. Students must also have their OSHA 10-hour card. Some technical areas may require additional certifications prior to entering the program.
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number
Cell Phone Number (necessary for work off-site)*
E-mail*
example@example.com
Birth Date

MonthDayYear
Place of Birth (City & State)
Color of Hair:
Color of Eyes:
Technical Program:
Certification Numbers:
O.S.H.A. 10 Hour (General Industry ) Required*
Additional Certificate Number:
Additional Certification:

O.S.H.A. ConstructionServSafeCNACosmetologyOther
Student Employment Information
Do you have your own transportation to/from the job?*

YesNo
Do you have a driver's license?*

YesNo
License Number:
Please answer how you will get to/from work?
How far are you willing to commute to work sites? Some employers work several miles from the school and require students to be on the road early. Maximum:
Miles:
Minutes:
Are you available to work after school if requested?

YesNo
Are you available to work full time (40 hours) during your shop week?

YesNo
Please list any days and/or hours that you are unable or unwilling to work?
Do you agree to follow all the rules and regulations for participation in this program as outlined in the student handbook?*

YesNo
Parent/Guardian Information
Parent Name*

First NameLast Name
Parent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Parent E-mail*
example@example.com
Teacher References:
Teacher Reference *
Name of Reference
Class*
Teacher Email
Program Approval
Program Lead
Program Lead Email
Resume:

Formats pdf, doc, docx, txt, rtf.
Resume*

Cancelof
Send Application:
The statements and information furnished in this application are true and complete.

My signature certify that I have read and agree with the above statement.
Student Signature

Clear
Should be Empty:

Co-op Application Form

Personal Information:

Certification Numbers:

Student Employment Information

Parent/Guardian Information

Teacher References:

Program Approval

Resume:

Send Application: