Job Shadowing Application

Student Name_______________ Date_

Mailing Address_____________________Phone__________Cell Phone________

Birth Date_____________Age_________Grade Level:(CircleOne) 10 11 12

Please list a specific business and person you will be shadowing.

Business Address and Phone Number:_________________________________________

I understand that job shadowing will allow me to experience first hand what an occupation is really like and that my primary role will be to observe.
I agree to abide by school and job site policies and to be prompt, loyal, confidential, respectful and dress appropriately for my job shadowing experience.
I understand that if there is a problem with my job shadowing experience, I will contact Ms. Berry or Mrs. Hillman
If for some reason I cannot attend my job shadowing experience, I agree to notify Ms. Berry or the high school office so that she can call the business. I also understand that it must be an emergency situation that would keep me from my job shadowing experience.
I further understand that in order to participate in the job shadowing experience, transportation to and from this experience is my responsibility.
I understand and accept the responsibilities expected of me during the job shadowing experience.
I will keep a daily journal about work and turn this in at the end of the job shadowing.
Job shadowing will be 50 % of my grade and the remaining 50% will be made up of class assignments.

Student Signature________Date

I approve my child’s participation in the job shadowing experience and will support him/her in successful completion of this learning opportunity.

Parent’s phone number;W:_____________________H:_____________________

Parent’s e-mail address;W:_____________________H:_____________________

This applicant is approved to participate in the Job Shadowing experience.

Counselor Signature__________________________Date_____________________

Principal Signature___________________________Date_____________________