Work-Based Learning Interest Form-2022/2023
Please complete the fields below if you are interested in applying for Work-Based Learning to earn elective credit for your current job. Final approval for enrollment will be determined in August after completion of the full application document, verification of your employment and a meeting with Mrs. Bynum, the Work-Based Learning Coordinator. If you have questions or need additional information, please contact Mrs. Bynum at joi.bynum@clayton.k12.ga.us. Thank you!
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Email *
First Name *
Last Name *
Date of birth *
MM
/
DD
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YYYY
Email address *
Cell Phone Number *
Do you have reliable transportation? *
Are you currently working? *
Employer (If you're not employed yet state "N/A") *
Employer address
Supervisor's Name
Supervisor's phone number
Job title
Hourly wage
How many hours a week do you work?
What was your hire date
MM
/
DD
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YYYY
What is your career objective? *
Please list any courses have you taken related to your career objective?
A copy of your responses will be emailed to the address you provided.
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