THE SCHOOL BOARD OF ST. LUCIE COUNTY
Referral for Job Coaching Services or Employment Assistance
School
Date Submitted
Name of Student
ID#
Social Security Number
Telephone
Mailing Address
City
State
Zip Code____
Date of Birth
Current Age
THIS SECTION IS TO BE COMPLETED BY THE STUDENT. PLEASE CHECK SERVICES REQUESTED FROM
THE JOB COACH.
Résumé
How to complete a job application
Monthly employer evaluations
Job shadowing opportunities
Assistance with referrals to agencies
Monthly follow-along services for
employed students
Interview Skills
Mentoring
Un-Paid work experience
Video-Interviewing
Transportation Information
Comments: ___________________
______________________________
Student’s Signature ________________________________________________________
THIS SECTION MUST BE COMPLETED BY SCHOOL PERSONNEL. CHECK ALL THAT APPLY
What is the student’s cumulative GPA?
Has the student participated in a vocational aptitude assessment or completed an
interest inventory?
Is the student enrolled in vocational education or a TECH/PREP Academy?
If yes please list the courses completed to date.
FROM THE LIST BELOW, PLEASE INDICATE AREAS OF NEED OR NEEDED IMPROVEMENT FOR THE
STUDENT.
Attendance
Ability to demonstrate on-task behavior
Hygiene and Personal Appearance
Verbal Communication
Ability to follow more than one
step directions
Attitudes toward peers
Non-verbal communication
Social Skills
Comments:__________________
____________________________
Teacher’s Signature_____________________________
Please submit completed copy to Lesa Kitzmiller at the ESE Office.
White-Job Coach
Yellow-School ESE file
Pink-Parent
XED0131 Rev. 2/05