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DuBois Area High School
Groundhog Day .Job Shadow Permission Form
I
425 Orient Avenue I
DuBoi~,~PA 15801
Phone: (814) 371-8111Fax: (814) 371-3928

Students wishing to engage in a job shadowing experience need to :omplete tfle f\ollowing items.
Before job shadowing students must: \
□ Contact the job shadow site of their choice and fill out the St1 1dent Section 1
□ Have Parent/Guardian complete Section 2
□ Show form to Homeroom Teacher by Friday January 27 for p eapproval
o Please note:
• Students will not be excused if they t ave missed 10 or more
school days.
• Students may not visit the same exact sit-e and career more than
once.
During job shadowing students must:
□ Have their job shadow supervisor fill out the Job Shadowing ~ upervisor Section 3
□ Complete the supervisor interview section on the back
After job shadowing students must:
, □ Scan the completed form to their Student Drive when forms a:-e returned to you and save your
original- NO COPIES WILL BE KEPT BY SCHOOL STAFF

1: Student Section -
Student's Name: Zo. Ch Fa. a:c \\
Grade: C\ '
Job Shadow career: 0 perQ-\1 OV\ ~ l' CC(\Cl. ~ e. V
1
\

Business Name: Uo \ ±ed E\-ec i-c\c

Supervisor: (~\\ l( Lf\F- r -
·, ff::, \ \ I Phone: - ~ 14- ,- i"5'q I / '53 dl0
Date of Job Shadow: February 2, 2017 Time of excusal: 7:45 ar 1
L Time of return: 2:35 pm

2: Parent/Guardian Section
I give permission for rry~d~u,9hter/so~ ~
? bT e~c~s~_d f~r_the above jc b shadowing e~p~rience.
Parent's Signature:f [JV \ j \ I ) , ,1 -1 1 JJ 1.: '·- <JL,\~ Date: l - O \ ,___) - \ 1
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CJ' ~ I /o V (I ,7 , ')
Primary Phone:
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y _ Site Supervisor on the day of the shadow
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Date·
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ervisor Se,...,.
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s· : Arrival.a I:C? 0 Pf'J\ Departure Time: 1/ 1(IVf ,,,_.
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To he complet,~d at the job shadow site by Student

Supervisor Interview

I I--I did you become interes~ein this field? ~ . , i-e,d.. Iv /Ii

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·> What is a typical workday like ~0~ 0,,,,_J., ,ov.t ~p/Y'l-c--'..\- "lt:}r
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3. What are your job duties?
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-I-. What is the best educational pr •paration for this field? Do you recommend a certain institution?
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5. What skills are needed in this ( eld and which one can / should I focus on at this point in my education?-
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6. What personal attributes do yq I feel are essential for success in this field? "'·
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7. What experiences &ave you hac that better ;repared you for your job? <z;1TQS
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8. What is your favorite aspect ab! ut your job? ,

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9. What are some difficulties, and what motivates you to continue in this field despite them?
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10. What is the future job outlook? , \... ~ ~.-<;\f'i'l\o
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11. What types of advancement opf ortunities are available in this field?
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12. Do you know of comparable job titles that I should be exploring in this field?
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13. vVhat professional journals or o ·ganizations should I know about in this field?
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14. vVhat else should I know in ordj r to make an informed decision about going into this field?
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 l -

DuBois Area High School

Groundhog Day Job Sh 11 • •
425 Orient Avenue auow Perm,ss,on Form
DuBois, PA 15801
Phone: <814) 371·8111 Fax: (814) 371-3928

Students wishing to engage in a job shadowing experience need to complete the following items.
Before job shadowing students must:
□ Contact the job shadow site of their choice and fill out the Student Section 1
□ Have Parent/Guardian complete Section 2
□ Turn in form to History Teacher by Friday, January 26 for preapproval
o Please note:
•
Students will not be excused if they have missed 10 or more school
days.
• Students may not visit the same exact site and career more than once.
During job shadowing students must:
□ Have their job shadow supervisor fill out the Job Shadowing Supervisor Section 5
□ Complete the supervisor interview section on the back
After job shadowing students must:
□ Scan the completed form to their Student Drive when forms are returned to you and save your
original - NO COPIES WILL BE KEPT BY SCHOOL STAFF

1: Student Sectio History Teacher: Hts . \\j Oco S

Stu dent's Name: ' · ----.. · · Grade:-· 11 l·0-;,- ~-.
Job Shadow Career: ->;,,,""""'"'i,---:;.....,,,.,_.__._.,....._--'..-<.>.<.'--"1--.,__,._,.,_ Business Name: MR\t\:u.LJ}~ Jcl-e:.rrah~ .
Supervisor: Phone: i,:-\,- ~c;~ - 91olel~ -
Date of Job Shadow: February 2, 2018 Time of excusal: 7:45 am s·...orn~_
Time of return: __-=2:=3=- ""'"'
2: Parent/Guardian Section
I give permission for m qaughter/s0n t be e cused for the above job shadowing experience.
Parent's Signature: I . - Date: \~ - -~9-\'6
Primary Phone: _ _ _____!_l..L..l..:....__+--1-..l..\_-..:::D-=~
:.. .d_ _ _ _ __ _

3: DAHS Teacher Section:

Official Signature:
1
~'1J/. ~r~ _
Reviewed job shadow efferience~ m ·',/) Jill
Date: 1/_,, i I J t

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To be completed by Site Supervisor on the day of the shadow

Date: _..,.-+-l=lf--+-'..,___ _ Deoarture 1ime: \~O M

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Signature of Supervisor: olJ
~ioued oo Back
 providing our students with this ,io
The DuBois Area School District would like to thank you for
a job-shadow supervisor for other students please
shadow experience. If you would be willing to participate as
inator, Mr. David Volpe at
email the following information to the Job Shadow Day Coord
dvolpe@dasd.kl2.pa.us
first and Last Name
Business Name and Job Title
Email and Phone Number
experience more effective or beneficial?
Please let us know if there anything that we can do to make this

To be completed at the job shadow site by Stu den t

Supervisor Inte rvie w

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l. How did you become interested in this field? 1

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2. ~Jiat is a typical workday like? •
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3. What are your job duties?

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4. What is the best educational preparation for
this field. Do you recommend a certain institution? 7
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5. Whafslillls are~ eededi n~this' fit!ld and which one
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6. W~ personal attributes do you feel are essential for success
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job?
7. What experiences have you had that better prepared you for your
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8. What is your favorite aspect about your job?

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in this field despite them?
What are some difficulties, and what motivates you to continue
9.
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10. What is the future job outlook? .,4 .I ,,.J AA _ d"-'f ..:J
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Wpat types of advancement opportunities are available in this
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12. Do you know of comparable job titles that I shoul
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13. What professional journals or organizations shoul
d I know about in this field?
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14. What else should I know in,order to make an
informdd decisiQ,E__~bout going into this field?
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