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					                             Blue Mountain Action Council
                               Work Experience Program
                              Worksite Job Description Form

It must be understood that this is a training experience, and the trainee must not replace
regular employees or infringe on their hours in any way.


BUSINESS/AGENCY: ____________________________________________________

Address:________________________________________________________________
             Number                              City

ON-SITE SUPERVISOR: ______________________ WORK NUMBER:____________

BACK UP SUPERVISOR:__________________________________________________

JOB TITLE OF POSITION REQUESTED:_____________________________________

NUMBER OF POSITIONS REQUESTED: _____ START DATE:_________________



NATURE OF WORK: (General Description)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________



DESCRIPTION OF EQUIPMENT, TOOLS, OR MACHINERY WHICH WILL BE USED:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________



DESCRIPTION OF THE MINIMUM KNOWLEDGE, ABILITIES, SKILLS DESIRED:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________


                                                                          Updated 8/22/2012
PHYSICAL DEMANDS:
___________________________________________________________________________
___________________________________________________________________________



EDUCATION SKILLS REQUIRED (Check the ability needed to perform job)

                                                               Low       Average       High
                                       Reading:                ____       ____         ____
                                       Writing:                ____       ____         ____
                                       Math:                   ____       ____         ____
                                       Other: _________        ____       ____         ____



WORK SCHEDULE: (example: 7:30-11 or 11:30-4)

Monday _______________________                 Friday ________________________

Tuesday _______________________                Saturday ______________________

Wednesday _____________________                Sunday _______________________

Thursday _______________________               Total Hrs. Per Week ____________



Will there be access to confidential information? _____ Yes            _____ No
Drivers License Required?                         _____ Yes            _____ No
Is a criminal background clearance required?      _____ Yes            _____ No


Will you consider a modification of the schedule/total hours if it remains within the hours
stated above? ______ Yes _______ No



_____________________________________            _________________________________
Work Experience Participant                      Worksite Supervisor




Blue Mountain Action Council                    342 Catherine Street, Walla Walla WA 99362



                                                                            Updated 8/22/2012

				
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