School Site Work Experience Learning Agreement

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Work Experience Learning Agreement This commitment must be read, understood, and signed by the student and the XXXXXXX., (“Company”). It will also be signed by Hillsboro School District (“The School District”) Representative and the parent, if appropriate, to ensure that all parties concur with the goals and expectations of the work experience. Name of Student: ___ Company or Organization: _ _____ XXXXXXX.______________________________ Address of Work Experience Location: ____________________

Contact Person: _

________ Title: ____

Telephone:_________________________FAX:_503-693-6695_E-Mail:____________ The work experience is set up for __ __ hours per day The work experience will be unpaid Work Experience Schedule: Begins ___/_ _/__ Ends ____/__/__ Planned Absences:______________ Monday

Tuesday

Wednesday

Thursday

Friday

*See attached calendar for schedule for “Day 2”. See attached transportation plan The student will report to Name: __ __________ Title:_ Work Experience Goals/Learning Objectives: Work Habits 1. Quantity of Work: Assess rate or amount of work completed with acceptable quality. 2. Independence: Assess ability to complete average amount of work after directions have been given with minimum to some supervision to complete work duties. 3. Initiative: Assess ability to demonstrate initiative, helping with extra tasks if directed. 4. Attendance/Punctuality: Assess performance using work standards, including student calling in to report any absence.

Work Communication 1. Adaptability: Assess ability to learn new tasks when required, and make changes if asked. 2. Asking for Help: Assess ability to ask for help when needed or ability to ask questions in order to clarify directions. General Responsibilities and Duties:

Special Restrictions/Accommodations

Student/Trainee agrees to accept, and Parent/Guardian to support the following responsibilities (read and student initials each statement below): 1. I will arrive at my job site at my scheduled time (Initial: ______) 2. I will work _______hours per week/day and record my hours correctly on my time sheet. (Initial: ______) 3. I will dress appropriately according to the standards of dress set by my job site. (Initial: ______) 4. My Hillsboro School District Representative’s name is: _ ______)

________________. (Initial:

5. I will make every effort to attend all special activities that have been planned for me. (Initial: ______) 6. If I am sick, I will immediately contact my mentor at _______ and Mrs. at ____. (Initial: ______) Ms : _____________or at: ________________. (Initial: ______) Note: 24 hours’ notice should be given. 7. If an accident or injury occurs, I will notify my The Hillsboro School District Representative immediately. (Initial: ______) 8. I will not make or receive personal phone calls from the worksite or use worksite equipment or supplies for personal use. I understand that if I am assigned to a computer workstation, I will not abuse my privileges by using my system for games, chat rooms, or sending unauthorized electronic messages. (Initial: ______) 9. I understand that Company has an Alcohol and Drug Free Workplace. I will not use, possess, buy, sell, offer for sale, manufacture or dispense alcohol, illegal drugs, or intoxicants (includes possession of drug paraphernalia) at the worksite. I will not be under the influence of alcohol, intoxicants, or an illegal drug, including arriving to the worksite or returning from a meal or break under the influence.

10. I understand that Company may remove me from the worksite because of my behavior, attendance, attitude, or aptitude,. Hillsboro School District will be notified as soon as possible of any disciplinary actions and or removal from the worksite.(Initial: ______)

11. I understand that the primary purpose of this work experience is to develop pre-employment and employment skills as identified in the Work Experience Goals/Learning Objectives. I understand that I am not entitled to wages or other compensation for the time spent in the learning experience. I also understand that I am not entitled to a job at the completion of the learning experience. (Initial:________) 12. I understand that I will not socialize with any students either at the work site (school) or off campus during non-school hours.

Company agrees to accept the following responsibilities: 1. Provide thorough orientation to the job and work-site, as well as a meaningful, training/work experience. 2. Consult the school/program coordinator regarding problems related to the work experience. Company may request any Student’s removal from the internship experience for reasons including but not limited to Student’s behavior, attendance, attitude, aptitude, and failure to comply with the conditions set forth above; and Hillsboro School District will be notified as soon as possible of any disciplinary actions and or removal from the worksite. 3. Company may terminate the Program at any time, for any reason, upon notice to School. 4. Provide written evaluation of student/trainee performance and discuss with student/trainee. Provide time for consultation with, and on-site monitoring by authorized staff. 5. Maintain an accurate attendance and/or time records, as required. 6. Provide a safe work environment. Fill out the appropriate state accident reporting forms in the event of any accident, however minor, which occurs on the job. 7. Conform to all State and Federal regulations and local policies. 8. Accept students/trainees and assign work without regard to age, race, color, sexual orientation, political affiliation, disability, national origin, marital status, political status, religion, or gender. 9. The internship experience is for the benefit of the Student. 10. Company, by hosting the work experience, derives no immediate advantage from the activities of the Student and on occasion Company’s operations may actually be impeded. 11. The Student does not displace regular employees, but work under close observation of an instructor provided by School.

The School District agrees to accept the following responsibilities: 1. Conduct work-site visits as indicated by school or program guidelines. 2. Provide work-site with a liaison to assist in:    

explaining requirements completing paperwork resolving problems otherwise helping the student/trainee and work-site supervisor maximize work performance and learning objectives.

3. Not place any student in the Program at Office Depot who is under 18 years of age. 4. Provide a Certificate of Liability Insurance as follows:

a. Comprehensive General Liability (Bodily Injury and Property Damage) Insurance, in an amount not less than One Million Dollars ($1,000,000) per occurrence; and b. Automobile liability insurance in a combined single limit of One Million Dollars ($1,000,000) covering owned, hired and non-owned vehicles. School shall name Company as an additional insured, and shall be primary with respect to its coverage hereunder. All Parties agree and understand that: 1. This arrangement does not create any agency, partnership or employment relationship between Company and Student or School. Students are not employees of the Company nor entitled to any Company benefits or incentives; 2. The internship experience, even though it includes actual operation of the facilities of the Company, is similar to that which would be given in a vocational school; 3. The internship experience is for the benefit of the Student; 4. The Student does not displace regular employees, but works under close observation of an instructor provided by School; 5. Company, by hosting the internship experience, derives no immediate advantage from the activities of the Student and on occasion Company’s operations may actually be impeded; 6. Company may terminate the Program at any time, for any reason, upon notice to School District.

_________________________________ Student

____________________________________ Parent (if needed)

_________________________________ District Manager, Office Depot

____________________________________ ITS Hillsboro School District Supervisor