TECHNOLOGY ACADEMY WORK-BASED LEARNING APPLICATION
Name (First, Middle, Last) Social Security Number Date of Birth Address City, State, Zip Home Phone High School
U.S. Citizen (yes/no) Cumulative GPA (through 5 semesters) Rank/Number in Class Days Absent (1st Semester Junior Year) Days tardy (1st Semester Junior Year) Junior Class Schedule Senior Class Schedule
Math
Science/applied Science
Technology
The Following information will be used to assist in determining the best possible on-the-job experience for you. Answer the following questions as honestly and completely as possible.
What are your future goals? Short term - long term - 5-10 years?
What attracted you to the Cooperative Work Experience/Work-Based Learning Program?
What type of skills/knowledge do you hope to gain as a student employee?
What is your greatest strength?
How would you describe your personality type? (outgoing, quiet, assertive, other) give examples
Do you prefer to work in a group setting, independently, or both? Why?
What are your short and long range educational plans after high school graduation? What kind of work do you see yourself doing in the future? In your opinion what are the most important attributes of a good employee? What are your favorite subjects in School, and why? What are some of the extra curricular activities in which you nave been involved? Will you be participating in extracurricular activities that might conflict with work hours? (Employers may be flexible, but we need to know NOW about potential conflicts.) List honors received and/or offices held in clubs or other activities. Check when you would be available to work. (Standard hours are 7:30 am to 4:00 pm. You must be able to work a minimum of 15-20 hours per week.) ________ Morning ________Afternoon Do you have your own transportation to get to and from work ___Yes ___ No List the names and relationship of all family members who are employed by Battelle, your School District, Siemens, or Washington Public Power Supply System. (names, relationship and company.) List any classes you have taken that are computer, technology, or science related. WordPerfect 5.0 Microsoft Word Paradox WordPerfect 6.0 Microsoft Excel dBase lll Plus WordPerfect 6.1 Microsoft Access CADD Lotus 1-2-3- Microsoft PowerPoint Windows 95 Quatro Pro Microsoft Outlook Windows 98 Internet References - 3 Required Name Address City/State/Zip Phone The following information will be used for equal employment opportunity purposes and is strictly voluntary. 1. Sex male female 2. Identify your ethnic background Alaskan Native/American Indian. Include origins in North America, maintains cultural through tribal affiliation or commnuity recognition. Asian. Includes origins in Far Fast, Southeast Asia, Pacific islands, Indian Subcontinents (China, Japan, Korea, Philippians, Samoa, Vietnam, India, Pakistan). Black. Includes origins in any black racial group. Caucasian. Includes origins in Europe, North Africa, Middle East; Not Hispanic or East Indian. Hispanic. Includes origins of Mexico, Puerto Rico, Central or South America or other Spanish culture.
What are your short and long range educational plans after high school graduation?
What kind of work do you see yourself doing in the future? In your opinion what are the most important attributes of a good employee? What are your favorite subjects in School, and why?
What are some of the extra curricular activities in which you nave been involved?
Will you be participating in extracurricular activities that might conflict with work hours? (Employers may be flexible, but we need to know NOW about potential conflicts.)
List honors received and/or offices held in clubs or other activities.
________ Morning ________Afternoon
Do you have your own transportation to get to and from work ___Yes ___ No
List the names and relationship of all family members who are employed by Battelle, your School District, Siemens, or Washington Public Power Supply System. (names, relationship and company.)
List any classes you have taken that are computer, technology, or science related.
WordPerfect 5.0 Microsoft Word Paradox WordPerfect 6.0 Microsoft Excel dBase lll Plus WordPerfect 6.1 Microsoft Access CADD Lotus 1-2-3- Microsoft PowerPoint Windows 95 Quatro Pro Microsoft Outlook Windows 98 Internet
References - 3 Required
Name
Address
City/State/Zip
Phone
1. Sex male female
2. Identify your ethnic background Alaskan Native/American Indian. Include origins in North America, maintains cultural through tribal affiliation or commnuity recognition. Asian. Includes origins in Far Fast, Southeast Asia, Pacific islands, Indian Subcontinents (China, Japan, Korea, Philippians, Samoa, Vietnam, India, Pakistan). Black. Includes origins in any black racial group. Caucasian. Includes origins in Europe, North Africa, Middle East; Not Hispanic or East Indian. Hispanic. Includes origins of Mexico, Puerto Rico, Central or South America or other Spanish culture.