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