JOB SHADOW APPLICATION
Applications due by August 22, 2008
Company Infromation
Company
(Sorry! Home-based businesses are not eligible to participate.)
Company Website
Coordinator/Contact Person for Job Shadow Day
Name/Title: Phone:
Fax: ______ E-mail: _____________________________________
Type of Business: ________________
MailingAddress _________________ City: _____________________________Zip:
Shadow Infromation
Title of Occupation to be Shadowed: _________________
(Please use a separate application for each occupation)
Employer Mentor: _________________
(Please provide name & title)
Number of Shadow Openings Student Reporting Time (no later than 9 A.M.) __________
Special Instructions for Reporting: _________________
Street address: City: Zip: Complete address of Job Shadow work site where students report:
Explanation of Work: _________________
_________________
- Certificate of Insurance:
A Certificate of Insurance must be on file with the CCPS and the Chamber to be eligible to participate in Job Shadow Day. (Your insurance company can provide a Certificate of Insurance at no additional cost) For complete details see the CCPS Certificate of Insurance letter. Chamber Fax: 410-876-1023
- Student Information:
After registration the applications will be distributed among the high school Career Coordinators who will then match students with the occupations. By mid October a Career Coordinator(s) and students(s) will contact the company’s coordinator/contact person.
Reservation Form
Job Shadow Luncheon – Martin’s Westminster – 1:00 pm on Thursday, November 13, 2008
| Company Name | Amt Due |
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| Number of students | $23.00 |
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| Mentor/Representative | $23.00 |
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| Mentor/Representative | $23.00 |
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| Mentor/Representative | $23.00 |
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| Mentor/Representative | $23.00 |
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| Mentor/Representative | $23.00 |
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| Mentor/Representative | $23.00 |
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Total Amt. Due |
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Check enclosed: ___ Credit Card: __ Visa ______ MC Receipt Requested Fax: ______________
Credit Card#: _______________ Exp. Date: /
Application due August 22, 2008 Fax: 410-876-1023
Carroll County Chamber of Commerce Job Shadow Day P.O. Box 871 Westminster, MD 21158