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ETC WBL Employer Questionnaire
To be completed by partnering company representative
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* Indicates required question
Email
*
Your email
Eastside Technical Center student's last name.
*
Your answer
Eastside Technical Center student's first name.
*
Your answer
Name of representative completing this form.
*
Your answer
List job title.
*
Your answer
Office Phone Number
*
Your answer
Cell Phone Number
*
Your answer
Company Name
*
Your answer
Company Street Address
*
Your answer
Company City Location
*
Your answer
Company Zip Code
*
Your answer
How many hours per week will the student be with the company?
*
9 hours
15 hours
24 hours
30 hours
Our company understands that the student must receive 15 hours per week for a Southside Technical Center student.
*
yes
No
If an hourly wage is going to be paid, what will that wage be for this student? (if no wage then type no)
*
Your answer
List the job responsibilities that the work based learning student will be completing with your company
*
Your answer
We agree to submit the weekly electronic performance review for the student in the work based learning program.
*
yes
No
A copy of your responses will be emailed to the address you provided.
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