WORK BASED LEARNING PERMIT
SECONDARY
Program: _________________________________________ Date: ______________________
Name of Student: ______________________________________________________________
Has my permission to work at:
Employer: ______________________________________
Address: _______________________________________
Phone: _________________________________________
As part of the student’s training in technology education, I understand that regular Career-Tech credit will be
given for this supervised work. I further understand that the Gordon Cooper Technology Center will not be
responsible for accident or injury to the student while traveling to and from this job and/or on this job.
Nature of work: ________________________________________________________________
Duties: _________________________________________________________________
Start Date: ____________________ Hours: ____________ End Date: __________________
Gordon Cooper Technology Center has permission to release personal information to prospective employers
when requested for OJT assignments or job placement.
Parent or Guardian Signature: ________________________________ Date: ______________
Approved by:
Career Tech Instructor: _____________________________________ Date: ______________
Industry Official: __________________________________________ Date: ______________
Partner School Official: _____________________________________ Date: ______________
First Year
Second Year
Grade: __________ 1st Semester
Grade: __________ 2nd Semester
Grade: __________ 1st Semester
Grade: __________ 2nd Semester
Attendance: Number of days absent __________ 1st Semester __________ 2nd Semester
Rating Scale
Proper Safety Skills
Proper Attitude
Entry Level Competency
Job Relevant to Training
1
2 3 4
Grade Point: __________ (16)
Attendance: __________ (8)
Rating Scale: __________ (16)
Total:
__________ (40)
Total/10
Attendance
0-1 = 8
8-9 = 4
2-3 = 7
10-11 = 3
4-5 = 6
12-13 = 2
6-7 = 5
14-15 = 0
Approved by: ________________________________ Date: ___________________________
Career Tech Administrator
Drug Test Administered
Interview with Principal
On-the-Job Training Procedure for Instructors
On-the-Job Training is a Privilege: Responsible work behavior is required to maintain Gordon Cooper
Technology Center OJT
Student selection is based on:
1.
Instructor’s recommendation
2.
All tuition and fees paid in full
3.
Classroom and shop participation being above average
4.
Attendance
5.
Work Attitude
6.
Reliability
7.
Appearance
Other criteria
1.
2.
3.
4.
5.
6.
7.
If a student has been in another program the first year, both instructors must be involved in
consideration for OJT.
Students must not have been absent, tardy, or check out early from class more than 15 hours in the
preceding semester.
Before the student is granted OJT permission, the instructor should make a personal on-site visit
with any prospective OJT employer. The instructor will explain the OJT program, discussing and
developing an understanding of the student evaluation and attendance records required. It is
important the employer understand that the student may need to miss work sometime for District
and/or State Youth Group contest and end-of-school activities.
All information on the Work Based Learning Permit should be complete before packets are filed in
the administration office. Teachers are responsible for filing the packet in the administration office
prior to the student beginning OJT.
The paperwork to be signed by the partner school administrator, instructor, parents or guardians,
employer, student, and Career Tech administrator prior to the student’s release to go to work.
At least one visit and/or telephone call should be made to each OJT employer by the instructor
within two weeks of the student being on the job. Follow up visits/calls should be made on a
regular basis of every two weeks.
Should an OJT student miss work, the instructor should record the absence in their grade book as a
absence and also notify the registrar of this day(s) absence.
On-the-Job Training Guidelines
______________________________________ agrees to abide by all regulations and under the supervision of
Gordon Cooper Technology Center and the partner school during all school hours.
If the above-name student should, for any reason, be absent it is her/her responsibility to notify Gordon Cooper
Technology Center and his/her employer. This should be done as soon as the student is aware that he/she will
be absent.
Any student who violates or abuses the OJT Program will be suspended from the program and must return to
school full-time.
In order to continue OJT, a student must maintain a good report from ________________ High School.
Student’s Signature: ________________________________________________ Date: _________________
Parent’s Signature: _________________________________________________ Date: _________________
Partner School Principal’s Signature: ___________________________________ Date: _________________