Thomas County Central High School

Thomas County Central High School Work-Based Learning Program Training Agreement Michelle Ausley, Coordinator 4686 U.S. Hwy 84 Bypass Thomasville, Georgia 31792 (229) 225-5050, ext. 192 Circle Program: YAP COOPERATIVE INTERNSHIP ESD

(Training Period: August 4, 2014 – May 15 or 21, 2015)

Please print all information.

Student’s Name (including middle initial): ______

Parent/Guardian’s Name: ______

Parent/Guardian’s e-mail address: ______

Student’s Employer (Business Name): ______Phone______

Business Mailing Address: ______

______

Work-Site Supervisor’s Name: ______Title:______

Work-Site Supervisor’s E-Mail Address: ______

Beginning Employment Date: ______Hourly wage: $______

Student’s Conditions:

1. SIGN IN or SIGN OUT on the form in the three-ring binder at front office or P.R.E.P. office each day. 2. Complete and submit on time and without complaint all WBL assignments required by the program. 3. Remain employed through the entire school year (through May 21, 2015, or May 15 with employer approval). 4. Provide transportation to and from work. 5. Represent the school and employer by demonstrating honesty, punctuality, courtesy, and a willingness to learn. These include refraining from cell phone use and dressing according to workplace standards. 6. Attend school every day (exceptions made for illness, emergencies, death in family). Work-Based Learning Training Agreement Page 2 of 5

7. Communicate to the coordinator concerns or problems occurring within the workplace and keep confidential information confidential. 8. Maintain high academic and work performance. 9. Work a minimum of 15 hours per week for three elective credits, 10 hours per week for two elective credits or 5 hours for one elective credit. 10. Make employment changes only with the approval of Mrs. Ausley. 11. Adhere to all employer, school, and program policies. 12. Understand that Mrs. Ausley and the employer will evaluate performance. 13. Maintain and submit records/forms by the stated deadline. 14. Maintain a calendar of due dates of forms, meetings, hours worked and any other information/dates pertinent to the program. 15. Maintain an overall C Average (2.0 GPA) in all subjects. (YAP B Average (3.0 GPA). 16. Master workplace skills outlined in the training plan. 17. Understand that being terminated from employment due to student negligence or quitting your job before the contract period is over or quitting your job without Mrs. Ausley’s knowledge will jeopardize elective credits and is grounds for dismissal from the program. The student will receive a grade of 60 for the nine-week grading period. 18. Submit to a drug screening, fingerprinting, or background check, if required by an employer. 19. FOR YAP STUDENTS ONLY: a. Agree to earn a postsecondary credential in the career focus area b. Agree to work part-time in your career focus area while pursuing your postsecondary education 20. IMPORTANT: By signing this agreement, the student certifies that the necessary safety training for the position of employment has been conducted by the employer. The student understands that failure to comply with the safety procedures may result in personal injury or in injury to others. The student agrees to follow all the safety rules and regulations.

Parent’s/Guardian’s Conditions and Consent Agreements:

1. Encourage your child to fulfill his/her responsibilities at school and at work. 2. Direct questions about the child’s training, wages, or working conditions to the work release coordinator rather than the employer. 3. Assume full responsibility for your child after dismissal from school, including days when your child is not required to be on the job. 4. Provide the student with transportation to and from the work site and provide automobile liability coverage and 24-hour health care coverage. 5. Agree to all guidelines and policies and the conditions presented in this training agreement. ------

--continued on next page— Work-Based Learning Training Agreement Page 3 of 5

 Health/Medical: My son/daughter has purchased the 24-hour school health insurance coverage or is adequately covered by an individual (or family) health insurance plan.

I authorize the school or the employer to secure emergency medical treatment, if needed. I will assume all financial responsibility. The parent/guardian will be contacted as soon as possible.

Name of Mother/Legal Guardian ______Daytime Phone ______

Name of Father/Legal Guardian ______Daytime Phone ______

Emergency Contact Person ______Daytime Phone ______

 Transportation: My son/daughter has permission to drive to school and to work. My son/daughter will be covered by automobile accident insurance for the duration of the Work- Based Learning Program.

 Photo/Media Release: Permission is granted for my son’s/daughter’s photograph and name to be used for educational and promotional purposes (newspaper articles, newsletters, etc.)

 Drug Screening: As a condition of employment, some employers require prospective employees to participate in drug screening, fingerprinting, background checks, or other employer-related testing. If applicable, consent is given for my son/daughter to submit to required screenings/testing.

 Medical Release: Upon the event of accident or injury to the student during school hours, work hours, or travel to and from work or home, I, nor other family members, agree not to hold liable the school system, the work release coordinator, the employer or any other person/entity associated with the Work-Based Learning Program.

 Early Release for Unscheduled Work Hours: On days (or hours) the student is not scheduled to work, permission is granted for my son/daughter to be released from school during the work release times indicated on the student’s course schedule. The student is required to sign out (or sign in).

Employer’s/Work Site Supervisor’s Conditions:

1. Provide a mentor/supervisor for the student employee. 2. Be flexible with student’s work schedules for testing and other required senior activities. 3. Discuss job expectations with the student and give them an opportunity to correct problems/misunderstandings to enable them to learn from their mistakes. 4. Provide various work experiences that correlate with the student’s career objective. Work-Based Learning Training Agreement Page 4 of 5

5. Provide the student with paid employment at least the minimum number of hours released for WBL. (Fifteen hours for 3 class periods; ten for 2; five for 1) 6. Provide time for consultation with the work release coordinator. 7. Consult with the work release coordinator about continued conflicts/problems involving the student worker so that collaborative efforts can be taken toward resolution. 8. Conform to all federal, state, and local laws and regulations, including nondiscrimination against any applicant or employee because of race, color, sex, or national origin. 9. Allow performance of hazardous work for students under 18 only if (1) it is incidental to the training, (2) intermittent and for short periods of time, and under direct and close supervision of a qualified and experienced person, and (3) safety instructions have been given by the school and correlated by the employer with on-the-job training. 10. Develop a meaningful, structured, and progressive training plan. 11. Complete an evaluation (grade) form on the student once every nine weeks (4 evaluations per year). 12. Verify and sign monthly time sheet indicating student worked the hours stated. 13. IMPORTANT: By signing this agreement the employer certifies that the student employee has completed the necessary safety training for the current position of employment, the proper procedures related to the job requirements have been shown to the student, and in the case of an emergency, the student has been given instructions on what to do. 14. IMPORTANT: This program cannot accept students who work as independent contractors for a business that issues the student a 1099.

Work-Based Learning Coordinator’s Conditions (Mrs. Ausley):

1. Support the student in meeting the requirements of the program. 2. Inform students of necessary work schedule changes (because of testing, etc.) 3. Conduct supervisory visits to the student’s work site once per grading period. 4. Provide assistance with educational and training problems of the students. 5. Maintain records/grades required by the program. 6. Provide program guidance to maintain the integrity of the program. 7. Serve as liaison between students, parents, and employers.

The undersigned parties agree to these conditions in the implementation of this agreement and will adhere to the training plans developed by the employer and coordinator. The duties and tasks listed in the training plan and the program guidelines and policies are part of this agreement. Student Employee ______Date ______

Parent/Guardian ______Date ______

Employer/Supervisor ______Date ______

WBL (School) Coordinator ______Date ______Work-Based Learning Training Agreement Page 5 of 5

Federal law prohibits discrimination on the basis of race, color or national origin (Title VI of the Civil Rights Act of 1964); sex (Title IX of the Education Amendments of 1972 and Title II of the Carl D. Perkins Vocational Education Act of 1987); or handicap (Section 504 of the Rehabilitation Act of 1973) in educational programs or activities receiving federal financial assistance.