APPLICATION FOR
WORK-BASED LEARNING
TUCKER HIGH SCHOOL
Please print neatly
Full Name
Grade
Home Address
City
ZIP
Telephone No.
Date of Birth
Age
Fathers Name
Occupation
Mothers Name
Occupation
Fathers work phone number
Mothers work phone number
Your career objective
What career do you want to pursue when you graduate?
How many days were you absent from school fall semester?
What business courses (electives) have you taken?
Favorite subjects
Extra-Curricular activities
What do you plan to do after high school graduation?
WORK EXPERIENCE RECORD (LIST MOST RECENT POSITION FIRST):
Name of Business
Date Employed
Do you prefer to work with (check one):
Are you available for summer employment?
Will you drive to work? Yes
No
Rate Per Hr.
your hands
Duties Performed
machines/computers
Yes
No
If No, do you have transportation? Yes
What is your class schedule now?
Period
Subject
Teacher
1
2
3
4
5
6
7
Please return this application to Mrs. Powers in Room F214
Student Signature
Parent Signature
people
Date
No