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WORK EXPERIENCE REPORT

SUPERVISOR DETAILS
Contact name: ______________________________________________________________
Address: __________________________________________________________________
Telephone number: __________________________________________________________
Email address: _____________________________________________________________
LinkedIn Profile:____________________________________________________________

TECHNICIAN DETAILS
Name: _____________________________________________________________________

Home address:_______________________________________________________________

Telephone number: ___________________________________________________________

WORK EXPERIENCE
Date of Work Experience: May 1, 2010 – May 25, 2010 Total Hours Completed: 80 hours

Excellent Good Acceptable Poor


Attendance

Punctuality

Learning Ability

Motivation

Appearance

Ability to work in a
group
Relationship with
supervisor
Ability to follow/seek
instructions/guidance
Over all attainment

COMMENTS
As this Work Experience Report is part of the technicians’s Record of Achievement, your written
comments would be appreciated (continue overleaf if required)

Signed:________________________________ Date:________________________________

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