Job Shadow Application

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Job Shadow Application
Date:
Student
Student
Name:
ID:
Student
Address:
Grade:
Age:
Date of
Phone
Birth:
Number:
Person to Contact in
Phone
Case of Emergency:
Number:
___________________________ has my permission to participate in the ___ grade job shadowing
experience. I understand it is my responsibility to provide transportation to and from the job site, or
assign a trusted adult to provide this transportation. It is also my understanding that the student must
present proof of a job site visit to be excused from school.
I hereby release _______________________________ School District and the job site listed above
from any and all liability.
Signature of Parent/Guardian
Date
Job Site
Driver
Your Schedule: (this semester)
Course Name
Teacher
Room #
1
2
3
4
5
Guidance Counselor’s Name:
Transportation/Job Information:
Do you drive to school? ......................................................................................
Yes
No
If “No,” can you arrange for transportation to a job shadow? ...............
Yes
No
Would you consider job shadowing after school? ...............................................
Yes
No
Do you have a job after school now?
............................................................
Yes
No
If “Yes,” where are you working:
Which days and hours do you work?
What career area(s) are you most interested in?
Alaska Work Based Learning Guide
Job Shadow Application
September 2003
Page 1

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