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
Format: (000) 000-0000.
Cell Phone Number (necessary for work off-site)
Format: (000) 000-0000.
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:

Other
Student Employment Information
Do you have your own transportation to/from the job?
Do you have a driver's license?
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?
Are you available to work full time (40 hours) during your shop week?
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?
Parent/Guardian Information
Parent Name

First NameLast Name
Parent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
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

Upload a File

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
Should be Empty:

Co-op Application Form

Personal Information:

Certification Numbers:

Student Employment Information

Parent/Guardian Information

Teacher References:

Program Approval

Resume:

Send Application: