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(/)

Name

Student ID No.

Class

Phone No.

Date

Morning sign-on
time

Afternoon sign-off
time

Total ____ hours worked during the month of


Dept. Heads signature or
stamp after verification

Organization
Department
student assigned to

Hours

Date

Morning sign-on
time

Afternoon signoff time

Hours

Total ____ hours worked during the month of


Department
stamp

Shih Chien University Department of Applied English

Industry Placement Student Attendance Record


Additional copies of this form, if required, can be downloaded and printed from the Departments website.
To facilitate calculation, please enter hours worked during different months into different columns.

Please kindly help us fill out this form to serve as a record of the student having
completed _____ hours of work during the Placement period.

Contact person: Kimberley Tsai, Secretary email: kimberley@mail.kh.usc.edu.tw Phone07-6678888#4271 Fax


07-6679999

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