LAMBTON COLLEGE

WORK TERM AGREEMENT

The college must receive this form from the student within 7 days of Job Acceptance. (Please print clearly)
Neglecting to do so could result in non-registration/failure of the work term. (ALL FIELDS MANDATORY)
Student Name _________________________________________

Program ___________

Student #________________________

Year _________

Summer

Work Term

Term:

Fall

Winter

Company Name
Mailing Address
City

Company Website
Prov

Postal Code

Phone/Ext#
(
)
Contact Person

E-mail
Fax#
(
)
Title

To assist us in evaluating the academic potential of the duties and responsibilities of this position, please provide the following
information:
Student Position Title _____________________________ Start Date _____________________ End Date ____________________
Direct Supervisor _________________________________________ Title ____________________ Phone/Ext# ______________________
Direct Supervisors Email _______________________________________________
Major Responsibilities:

Student Hourly Wage _____________________

Hours Per Week _____________________

1. _________________________________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________________________________
3. _________________________________________________________________________________________________________________________________
4. _________________________________________________________________________________________________________________________________

Employer Responsibilities:

Direct the student in an employee-employer relationship

Provide orientation, training, supervision & a safe work environment in compliance with the Occupational Health & Safety Act & relevant regulations
Provide Workplace Safety Insurance Board (WSIB) or other insurance coverage as provided for your employees
Pay agreed wages as indicated above
Provide duties and responsibilities related to the capabilities of the program of study
Company/supervisor will provide performance feedback to the work term student in compliance with the student work term report
Honour the above contracted dates of the work term
Student may be monitored at the workplace by a Co-op Advisor
Contact the college should issues arise
Provide a written evaluation of the students performance and provide a copy to the student at the conclusion of the work term
Supervisors Signature ___________________________________________ Date _____________________________________________
Student Responsibilities: I accept employment with above named company and I agree to the following:

I understand that I am not permitted to accept other interviews or offers of employment

I understand that I am responsible to adhere to all company policies and procedures, and the policies & procedures for

Co-op students
I agree to complete my work term contract dates/hours with the above employer
In the event that I have difficulties while on my work term, I will contact my Co-op Advisor immediately
I understand my rights & responsibilities in accordance with the Occupational Health & Safety Act and relevant
regulations
Failure to comply with any of the above responsibilities can result in failure of work term

Students Signature ______________________________________________ Date _____________________________________________

For Office Use ONLY: APPROVED

NOT APPROVED Co-op Advisors Signature: __________________________

2013