Job Shadow Program Application

* fields are required

First Name: *

Last Name: *

Student ID (S) Number: *

How did you hear about the job shadow program?: *

Who the career center staff was? : *

Add a name if you select Other above: *

What presentation they were at?: *

CRN: *

Professor Name: *

Home Campus: *

Major: *

Phone Number: *

Tri-C Email: *

Personal email: *

What is your job shadow area of interest? (Examples: Human Resources, Cyber Security, Mechanical Engineering, Pediatric Nursing) If you are unsure, enter N/A.

First Choice: *

Second Choice: *

Preferred company:

What do you hope to gain from this experience? (Short answer): *

Have you completed/updated your Handshake profile?: *

What is your primary mode of transportation? (Select all that apply.): *

Personal vehicle
Public transportation
Rideshare/carpooling
Other

Do you grant us permission to share your name, email, and phone number with employers who could potentially host you for a job shadow? : *

Please fill in for other: *

It is the student's responsibility to cover the costs of his or her own transportation and food. Cuyahoga Community College assumes no responsibility for health or accident insurance.
I agree to have my contact information released to the employer for the purpose of the Job Shadow Program.
I agree to abide by all business policies and all school policies during my Job Shadow experience.
Job Shadowing is a privilege, not a right. Unprofessional indiscretions, during and after the Job Shadow Program, will result in your removal from the program and future programs at the sole discretion of the Career Center.

ATTENTION: Job Shadow opportunities are not guaranteed.

I acknowledge and agree to all of the above rules and guidelines of the Job Shadow Program.

Participation agreement: *

Waiver: *

As a volunteer, Ihereby acknowledge and understand that my participation in Cuyahoga Community College’s (the “College”) Job Shadowing Program (the “Activity”). involves inherent dangers, hazards and risks in which I may be exposed, the RISK OF PERSONAL INJURY, PROPERTY DAMAGE, AND POSSIBLE DEATH. Understanding fully that these dangers, hazards and risks may be present, I hereby voluntarily agree to be exposed to the inherent dangers and acknowledge that such acceptance is voluntary in the Activity.

In consideration for my participation in the Activity, I agree to follow the rules and regulations established by the College and the Organization at which I am job-shadowing (the “Organization”). I hereby, on behalf of myself, my heirs, executor, administrator, and assignees, assume all risks associated with my participation in the Activity. Therefore, I agree to release and hold harmless the College, trustees, officers, employees, agents, and representatives, volunteers, and all other entities acting in any capacity on its behalf, including the Organization, from any claims, injuries, damages, or death resulting from, or arising out of my participation in the Activity.

I assert that there are no health-related reasons or problems which preclude or restrict my participation in the Activity. Furthermore, I have adequate health insurance necessary to provide for and pay any medical costs, as a result of injury to my person, if applicable.

I also give my permission to be photographed, and allow the College to release any and all pictures for publicity purposes only.

I understand that I sign this Agreement as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written statement, have been made. I further state that I am at least eighteen years of age and fully competent to sign this Agreement; and that I execute this Agreement for full, adequate, and complete consideration fully intending to be bound by the same.

THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.

Sign Your Name: *

As a volunteer, I hereby acknowledge and understand that my participation in Cuyahoga Community College’s (the “College”) Job Shadowing Program (the “Activity”). involves inherent dangers, hazards and risks in which I may be exposed, the RISK OF PERSONAL INJURY, PROPERTY DAMAGE, AND POSSIBLE DEATH. Understanding fully that these dangers, hazards and risks may be present, I hereby voluntarily agree to be exposed to the inherent dangers and acknowledge that such acceptance is voluntary in the Activity.

I also give my permission to be photographed, and allow the College to release any and all pictures for publicity purposes only.

I understand that I sign this Agreement as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written statement, have been made. I further state that the participant is a minor who is at least sixteen (16) years old and that I am the parent or guardian of the participant and that I am competent to sign this Agreement; and that I execute this Agreement for full, adequate, and complete consideration fully intending to be bound by the same.

THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.

Signature of Parent/Guardian: *

Date: *

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