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KENT SCHOOL DISTRICT #415 Powered By Docstoc
					                                 ENUMCLAW SCHOOL DISTRICT #416
                               CAREER & TECHNICAL EDUCATION (CTE)

 Student Name - ______________________________________________________________________ Sex (circle) M F
                 Last                             First                    Initial

Address - ___________________________________________________________________________________________
                Street                                             City                 Zip

Home Phone - __________________________ Email - ____________________________                                             Birthdate ______________

High School Grade - _____________                     Age (16+) - ______________Name of Business__________________________

Business email address: _______________________________________________________________________________
Business/Worksite Address - ______________________________________________ City/Zip- ____________________

Job Title - ____________________________________Job Duties - ____________________________________________

Qualifying Class - _________________________________ Instructor’s Signature - _____________________________

Student Responsibilities (Failure to comply with any of the following may result in termination from the program):
     1.   To provide your own transportation to and from the job using public transportation or in a legally licensed and insured vehicle.
     2.   To become familiar with and conform to all student employee regulations and policies set forth by the employer and the coordinator.
     3.   To notify the Cooperative Education Coordinator within 24 hours if there is a change of work hours or if termination occurs.
     4.   To see that the employer receives progress reports and that they are completed and returned to the coordinator on the due dates.
     5.   That the in-school class is a vital part of the cooperative work experience program and that failure in the class portion will also result in failure
          of the work credit portion.
     6.   Short and long-term suspension policies will apply to the work experience program. If the student is expelled from school, they will be in
          violation of the contract, and the contract will be terminated.
     7.   To return the monthly hour form to the Cooperative Education Coordinator no later than two school days after the end of each month.
     8.   Document 180 work hours for each Cooperative Education class (0.5 credit/1 semester)
     9.   Any student working for their parent must provide the following: a copy of the business license, monthly copies of their paycheck, school hour
          Form, a training plan that shows students are learning job entry skills for the workforce.
Student Signature - _______________________________________ Date - _______________________

Parent/Guardian Responsibilities:
     1.   To assume responsibility for the conduct and safety of the student from the time they leave school until reporting to work. Likewise from the
          time they leave the job until they return to school or home. The Enumclaw School District assumes no responsibility or liability for student’s
          travel, conduct or safety once the student leaves school grounds.
     2.   To encourage the student’s active participation, punctuality, attendance, and personal growth in this program.
     3.   To support this agreement during the student’s participation in the work-credit program.

Parent/Guardian (Print) - ______________________________________ Signature - ______________________________

Parent/Guardian Address - ___________________________________________ City/Zip - _________________________

Parent/Guardian Home Phone - ________________________________ Work Phone - _____________________________

Employer (Learning Worksite Supervisor) Responsibilities:
     1.   To comply with state and federal guidelines and regulations health & safety, nondiscrimination, harassment, work rules for minors, and
          employee rights.
     2.   Comply with the nondiscrimination statement listed on the reverse side of this contract.
     3.   To provide the student employee with the same considerations given a regular beginning employee with regard to safety, health, social security,
          general working conditions, and other regulations of the organization. Employer shall adhere to all federal and state wage and hour laws.
     4.   Maximum working hours are dependent upon the student’s ability to work and still maintain satisfactory grades and state L&I regulations.
     5.   To notify the coordinator of any problems that the student is having on the job when, in the employer's opinion, the existing situation could be
          detrimental to the student’s continued employment.
     6.   To confer with the coordinator regarding the student’s on-the-job performance and to complete and return to the coordinator progress reports
          for grading the student.
     7.   Provide student with minor work permit and retain a copy on file
     8.   Employers comply with labor and industries standards especially WAC 296-126-130 variance and chapters 296-24 and 296-62 WAC; or WAC
Employer/Supervisor (Print) - ____________________________________Signature - _____________________________

Worksite Phone Number - _____________________ Fax - _____________________ Email - _______________________
Cooperative Education Coordinator Responsibilities:
     1.   To contact the employer/supervisor at the learning worksite periodically and become acquainted with the immediate job-site supervisor.
     2.   To become familiar with the nature of the work that the student is expected to perform and to assist the student if conflicts arise which may be
          detrimental to success on the job.
     3.   To endeavor to resolve any problems that arise from the student’s employment to the mutual satisfaction of all parties concerned.

Cooperative Education Coordinator - _____________________________________________________________________


The Enumclaw School District and the learning worksite employer assures compliance with state and federal guidelines and
regulations regarding nondiscrimination against any employee/student on the basis of race, color, national origin, gender, or
disability in recruitment, responsibility, and pay. Harassment of any employee/student with regard to race, color, national
origin, gender, or disability is strictly prohibited.

Employer/Supervisor Cooperative Education Program Orientation:

   Purpose of Cooperative Education      The Enumclaw School District Cooperative Education program provides an
                                          opportunity for students to take the skills and knowledge they have gained in the
                                          classroom and apply them as an employee at a worksite.
   Student Evaluation Process            Gradesheets and documentation required
   Learning Plan                         The student’s learning plan will relate to their job and 13th year plan.
   Master Business License               A minor work permit is required if students under 18 are employed.
   Fair Labor Standards Act              Must adhere to Fair Labor Standards Act
   New Employee Orientation              must address:
                                                L&I employment standards for minors
                                                On-the-job orientation
                                                Employer’s worksite safety and health program
                                                Location of first-aid materials
                                                How to report unsafe conditions and practices
                                                Use and care of personal protective equipment
                                                Emergency procedures
                                                Identification of hazardous materials – procedures to follow
                                                Sexual harassment and discrimination training including reporting

Cooperative Education program orientation was completed.

Employer / Supervisor Signature -     _____________________________________________ Date - __________________

Cooperative Education Coordinator - _____________________________________________ Date - __________________

Occupational Health & Safety

The Enumclaw School District requires that students involved in the Cooperative Education program have a safe work
environment and that the worksite adheres to all federal and state occupational health and safety requirements.

Accident Prevention Program       YesNoN/A               Material Safety Data Sheets
                                                                  (MSDS) as required
Required Personal Safety          YesNoN/A               Health and Safety Checks
Equipment                                                        YesNoN/A
                                                                 (i.e. worksite, WISHA, OSHA,
                                                                  Dept. of Health, Fire Dept., etc.)
Worksite Insurance                YesNoN/A               Variance Applications
                                                                 YesNoN/A WAC 296-125-030
                                                                  (equipment related)

Comments: ___________________________________________________________________________________________


This worksite complies with all health and safety requirements listed above. (These can be found in WAC296-125, WAC 296-
131, and WAC 180-50-315)

Employer/ Supervisor Signature - ______________________________________________ Date - __________________


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