Student Employment/Cooperative Education Application Form

Complete the form below. Then follow the directions at the bottom of the page to submit the form.

Program/Major: G#:
PCC Degree/Certificate: Date of Graduation:

Name:
Address:
City: State: Zip:
Phone: Email:
Are you authorized to work in the United States?
Yes
No
Are you interested in Cooperative Education credit?
Yes
No
What kind of job/internship are you seeking?


Consent to Release Confidential Information

Portland Community College shall follow all applicable state and federal laws, rules and regulations that apply to student records. All information contained in the college records which is personally identifiable to any student shall be kept confidential and not released except upon prior written consent of the student or upon lawful subpoena or other order of a court of competent jurisdiction.

Pursuant to my employment search, I hereby authorize PCC to release confidential information about me contained in the college records or documents on file in the Cooperative Education/Job Placement Office to all potential employers. PCC cannnot release job-related information to potential employers without this signed form.


Required Signature: __________________________________________ Date: _____________

Submit this form to the Specialist at your campus.




Links
General Jobs
Co-op Education
Homepage
Job Search Resources
Resumes
Info for Employers
Staff
PCC Homepage


Send comments or suggestions regarding
Student Employment and Cooperative Education pages to: Webmaster

Copyright 1996, Portland Community College
An Affirmative Action, Equal Opportunity Institution.

Last Modified: 2011.