Career Services - Co-op Survey

Personal Information

First name: MI: Last name:

Street address:

City: State: Zip:

Phone:

Email address:

Clark State major:

Total number of credit hours completed:

Employment Information

Are you currently employed? Yes: No:

If yes, full-time: part-time:

Name of employer:

Your job title:

Number of hours work per week:

If you are working, is your work related to what you are studying? Yes No

Would you be interested in a co-op position related to
your major in which you would earn money and college credit? Yes No

If yes, what type of position are you interested in?

What quarter do you plan to start co-op?

If no, do any of the following reasons apply?

I am already working in my field and do not need a co-op position.

The co-op positions do not pay enough. I would need to make $

I do not have enough time for a co-op job.

My GPA is lower that the 2.0 required to participate in co-op.

Do you have a functional resume? Yes No Is it in the job bank? Yes No