Form Test PageJob Shadow Evaluation Form (Company & Student)"*" indicates required fieldsI am a... Company StudentName* First Last Email* TitlePhone*Name of Company*Name of Student*Name of School*AnnaBotkinsChristian AcademyFairlawnFt. LoramieHoustonJackson CenterLehmanRussiaSidneySidney Opportunity SchoolDate of Job Shadow* MM slash DD slash YYYY Career Field Shadowed*Comments/FeedbackWould you like us to follow-up with you regarding this experience?* Yes NoWas this activity beneficial to your career planning?* Yes NoRate your Job Shadow Experience:* 5 - Excellent 4 - Very Good 3 - Average 2 - Below Average 1 - PoorGive one positive comment about your experience:*Provide one suggestion for improvement:*Workforce Partnership Programming Activity Request"*" indicates required fieldsName* First Last Email* Phone*School* Anna Botkins Christian Academy Fairlawn Ft. Loramie Houston Jackson Center Lehman Russia Sidney Sidney Opportunity SchoolGrade Level (select all that apply)* K-2nd 3rd-4th 5th-6th 7th 8th 9th 10th 11th 12thSelect AllWhat activity are you requesting?*Classroom SpeakerNinja ChallengeMobile Career Lab TopicHuman Resource Process (Applications, Resumes, Etc.)Mock InterviewsOther Activity (If Other, explain below)Explanation for "Other Activity"If classroom speaker is requested, what is your topic request?* Workforce Partnership & Hometown Opportunity Manufacturing Company and Careers Construction & Skilled Trades Company and Careers Healthcare Company and Careers Food/Agriculture Company and Careers Parts Suppliers and Logistic Company and Careers Other Topic (If Other, explain below)Explanation for "Other Topic"*1st Date requested:* MM slash DD slash YYYY Start & End time(s) requested:*2nd date requested (if needed): MM slash DD slash YYYY Start & End time(s) requested for 2nd date:Special Instructions/Comments:Student Employment Readiness EvaluationName First Last Date of Birth MM slash DD slash YYYY Current AgeSchoolAnnaBotkinsChristian AcademyFairlawnFort LoramieHoustonJackson CenterLehmanRussiaSidney High SchoolSidney Opportunity SchoolGraduation Year2021202220232024Mailing AddressPhone Number Home Phone Cell PhonePermission to text? Yes NoPersonal Email AddressDriver's License Yes NoState Issued ID? Yes NoReliable transportation? Yes NoBicycle/Walk Option Yes NoCopy of Your Birth Certificate? Yes NoCurrently Employed? Yes NoEmployer?Updated Resume? Yes NoDrug Screen Ready? Yes No Not SureExtracurricular Activities? Yes NoWhat Extracurricular Activities?What is student's career interests?Skills Applicable to EmploymentCounselor's InformationHas Student's Transcript Been Received? Yes NoHow Many Credits Does the Student Have?What is Student's GPA?Students Attendance (9-12): # of AbsencesStudents Attendance (9-12): # of TardiesHas Student Completed Their Junior Year ACT? Yes NoACT ScoreHas the Student Applied to College? Yes NoWhat College?
