Northwest Technical Center

71 South Main Street - St. Albans, VT 05478

802-527-6516

Co-op Application

Name: Phone: _______________________________ Address: _________________________________________________________________________________

School: Date of Birth: ________________ Age: _________

Parent/Guardian: Phone: _______________________________

Career Interests: ____________________________________________________________________________

What transportation do you have to and from the workplace? ________________________________________

Please list previous experience. (Most recent first)

Employer: Address: __________________________________

Dates of Employment: Job Responsibilities: _________________________

Employer: Address: __________________________________

Dates of Employment: Job Responsibilities: _________________________

Employer: Address: __________________________________

Dates of Employment: Job Responsibilities: _________________________

Please briefly explain why you want to train for this career:

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Student Date Co-op Coordinator Date

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Parent/Guardian Date