College of the Sequoias | Complete Online Work Experience Application

Banner ID:

First Name:

Last Name:

Email:*

This is the email address we have on file. If you would like to be
contacted through a different address, please change this field.

Confirm:*

I hereby confirm that this is my current email

Phone:*

Street Address:

City:*

State:*

ZIP Code:*

Number of Work Experience/Internship units you are requesting:*

1

2

3 (Max for General)

4 (Max for Occupational)

What is your area(s) of study?:*

Educational Goal:*

Major:

Certificate:

Occupational Goal:

Undecided:

Undecided

Job-Related Class (if applicable):

Work Experience Instructor Name?:*

Semester to participate in the Work Experience Program:*

Fall

Spring

Summer

Year to participate in the Work Experience Program:*

Have you previously enrolled in the program?:*

Number of units already completed:

Do you currently have a Job-Site/Volunteer-Site?:*

How long have you worked there?:

Your Employment Type:

Job

Internship

Is this a paid position?:

Yes

No

Approximate Hours Per Week You Work:

Company Name:

Company Address:

Company City:

Company State:

Company ZIP:

Company Phone:

Your Extension or Direct Line:

Your Position Title:

Supervisor Name:

Supervisor Email:

Supervisor Phone:

Agree:*

I UNDERSTAND AND AGREE

Certification:*

I certify that information submitted in this application is complete and accurate to the best of my knowledge

COS

Complete Online Work Experience Application

AE Form Web Part

COS

Complete Online Work Experience Application

AE Form Web Part

Please stop and read the following message before continuing to the Noncredit application! If you complete this noncredit application you will not be able to register for a credit course.

Click here to continue to the Noncredit Application