JOB SHADOWING APPLICATION
Jefferson
County High School
115 W.
Dumplin Valley Road
Dandridge,
TN 37725
(865) 397-7384
STUDENT’S NAME
_______________________GRADE_______DATE__________
In order to participate in Job Shadowing with JCHS, the job
site and employee must be approved and
you must have satisfactory grades
and attendance.
1)
Have you job shadowed during this school year?
YES or NO
If you
circled YES, you will not be allowed to job shadow again this school year.
2)
Career Area in which you are interested in Job
Shadowing: __________________
3) Do
you already have a job shadowing site?
YES or NO
If you circled YES, please list
where you will be and with whom you will be:
Job
Site:
__________________________________________
Site
Host: __________________________________________
Phone:
__________________________________________
4) Do
you need assistance to help you with a job site and employer? YES
or NO
Your grades, attendance, and
potential job site will be checked. You
will be notified within a week
about the status of your application.
………………………………………………………………………………………......
To be
completed by the Job Shadowing Coordinator:
Student_____________________________________________Class____________Date___________
_____Your
Job Shadowing Application has been approved.
Please note the job site, date, and time for which your Job
Shadowing
experience was approved:
Job
Site: _________________________________________
Site
Host: _________________________________________
Phone: _________________________________________
Date:
_________________ Time:
_______________
_____Your
Job Shadowing Application has not been approved due to the following reason(s):
___Unsatisfactory
Attendance
___Other
___Unsatisfactory Grades
____________________________
___Inappropriate job
site
____________________________
___Attendance Satisfactory
___Grades Satisfactory
___Ms. Rimmer Notified
___Teachers Notified
___Job Site Approved
___#1 Job Shadow Application
___#2 Contract Signed by
Parent/Student Liability
___#3 Form Signed by
Parent/Student
_______________________ __________
Job Shadowing
Coordinator Date
JOB SHADOWING INFORMATION AND CONTRACT
Job shadowing is an opportunity for you to spend a day in a
work-place learning what employees really
do on the job in a career field that
you are considering pursuing after high school, technical school, or
college
graduation.
In order to participate in the job shadowing experience,
fill out an application form and return it to Mrs.
Potter in the Career Tech
office. You will be notified if your
application has been approved. You may
choose your own site and host for approval, or Mrs. Potter will assist you with
an appropriate placement.
When your paper work and signatures have been submitted to Mrs. Potter then your Job Shadowing Day
will not count as an absence and you will
not lose your two points of “perfect attendance.”
Your
Responsibilities As A Student “Shadow” Include:
·
Being supervised by a work-place host at all
times during your job shadowing experience
·
Observing all workplace and school safety and
security procedures
·
Reading all orientation materials prior to
attending the shadowing experience
·
Dressing appropriately for your job shadowing
experience
·
Interacting with your work-place host
respectfully, courteously, and enthusiastically
·
Learning about the work-place host’s job,
industry, and the working world
·
Asking questions about the host’s job and career
·
Writing a thank-you letter to your host
·
Complete the Follow Up Report and return to Mrs.
Potter
I agree to abide by the Job Shadowing Requirements and
Responsibilities.
______________________________________ ________________________________
Student
Parent
Parental Permission Form and Release from Liability
And
Code of Conduct and Transportation Agreement
Mentoring, Job Shadowing, and
Internships
Jefferson County High
School
I/we
____________________________and ____________________________________, the
lawful parent(s)
or guardian(s) of:
Jefferson County High
School
(JCHS) Student _______________________________________________________
Hereby give permission for
the above mentioned student to participate in Mentoring, Job Shadowing, and
Internship Program
known as Work-Based Learning conducted through one or more of his or her
courses in the Jefferson County School
System.
Understand that I the parent(s) or guardian(s) of the above mentioned
student will be required to provide reliable
transportation enabling the
student to drive to the work-based learning site each school day. I am granting permission for the
above
mentioned student to leave campus at the time designated by the teacher or
Work-Based Learning Coordinator.
Release from Liability
We, the lawful parent(s) or
guardian(s) of the above mentioned student, and I the above mentioned student,
hereby release
Jefferson County, the Jefferson County Board of School
Commissioners, Jefferson County Director of Schools, all
employees of the
Jefferson County School System, including teachers, the Work-Based Learning
Coordinator, the Career and
Technical Counselor (CTE) of JCHS, and all
participants in the Work-Based Learning Program from liability for any and all
injuries, death, property damage, or other claims, including claims based on
negligent or other inappropriate, arising from or
occurring during
participation in Mentoring, Job Shadowing, or Internship Study known as
Work-Based Learning, whether
such claim arises at school or in the work
place. I further understand that
Mentoring, Job Shadowing and Internship study
involves the student working for
no pay or monetary compensation at a job site in the private sector. The school setting is
controlled by the school
system. The private employer is
not. Mentoring, Job Shadowing, and
Internship Study will subject
the student to an adult work environment
including the experiences and hazards normally found in the type of business
that
works with the student and particularly found in the employers work place.
Code of Conduct Acknowledgment
The lawful parent(s) or
guardian(s) and I the above mentioned student, hereby acknowledge that I/we
understand and have
received a copy of the rules of student conduct enacted by the
Jefferson County Board of School Commissioners listing
school rules and
consequences for violations under assertive discipline, the safety rules for
participation in Work-Based
Learning, and any and all rules of conduct given by
any teacher or Work-Based Learning Coordinator and agree to abide by
them under
penalties described by and enforced by the Jefferson County School System and
Tennessee Department of
Education.
Transportation Agreement
We the lawful parent(s) or
guardian(s) of the above mentioned student, and I the above mentioned student,
hereby agree to
provide reliable transportation the work-based job site on a
daily basis or as assigned by the teacher, work-based learning
coordinator,
school counselor or school administrator.
I further agree to abide by all state vehicle operation, registration,
and
insurance laws and school parking regulations.
Date(s) of student
participation: _____________ _____________ _____________ _________________________
Month Day
Year
Time
__________________________ _____________
Student
Date
__________________________ __________________________________________ ________________
Parent/Guardian
Parent/Guardian
Date
Emergency Phone Numbers:
Submit the name and phone
number of at least two persons that could be contacted in case of emergency.
JOB SHADOWING
FOLLOW-UP REPORT
Name
of Student _____________________________
Date
____________________________________
Number
of hours spent during Job Shadowing experience________________________
Location
of Job Shadowing Experience ______________________________________
Name
of Employer/Mentor________________________________________________
…………………………………………………
Describe
what you did or observed during your Job Shadowing experience.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
What
type of education is required for the job? _________________________________
If
college is required, what major should be pursued? ____________________________
What
does your employer like best about his/her job? ____________________________
_______________________________________________________________________
What
does your employer see as disadvantages of his/her job? _____________________
_______________________________________________________________________
Student’s
Signature___________________
Employer’s
Signature _________________
Please return this form to Mrs. Potter the school day
after your experience. If this
form is not
received on the school day after your experience, your
Job Shadowing Day will count as an unexcused
absence.
