Placement Record Form

STUDENT

1. Student Name :
2. Student ID No :
3. Intake :
4. Employer Name :
5. Student’s Address During Placement :
6. Tel No :
7. E-mail Address :

EMPLOYER

1. Company Name :
2. Employer’s Tel No :
3. E-mail Address :
4. Employer’s Address including Department :

INTERNSHIP PROGRAM

1. Start Date :
2. End Date (if know) :
3. Company Supervisor’s Name :
4. Company Supervisor’s position :
5. Company Supervisor’s Tel no :
6. Company Supervisor’s E-mail Address :
7. Job Specification :