Please check all the boxes below that apply to your work experience:

School

Home

Community

Paid

Volunteer

Student Name:                                                                      Grade:

Who did you work for?

How do you know this person?

Phone number:

Date started:        /       /         Date ended:        /       /         Total hours worked:

What did you do?

What job skills did you learn?

Evaluation:

Completed the task independently

Completed the task with reminders

Attempted to complete the task

Comments:                                                                                                                     

                                                                                                                                      

Signature of person you worked for:                                                      Date: