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Student Referral Form Job Placement/Work-based Learning Advisors: 1. The student referral form should be submitted to the WBL/JP office or mailbox by the student’s advisor. Your candid feedback is valued and needed to ensure students/graduates receive appropriate JP/WBL assistance. (Form revised per input from team of 21 human resource specialists 8/16/11.) 3. If you are referring a student for WBL enrollment, stress to the student it is important to contact the WBL staff for class requirements. Students not meeting WBL requirements will be dropped from WBL. Below are listed employability skills employers have identified as critical for success in the workplace. Please rate ________________________________________________________ so the WBL/JP staff may properly assist him/her. (Student name) Rate 1 – 5 (1=Poor, 2=Needs Improvement, 3=Average, 4=Above Average, 5=Exceptional) Note: Drug and Alcohol abuse are not listed for you to rate, but as you know, negatively impact employment. Comments:

WBL JP Student Referral Form

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12 34 5 12 34 5 Positive Attitude 12 34 5 Below are listed employability skills employers have identified as critical for success in the workplace. Please rate ________________________________________________________ so the WBL/JP staff may properly assist him/her. (Student name) 3. If you are referring a student for WBL enrollment, stress to the student it is important to contact the WBL staff for class requirements. Students not meeting WBL requirements will be dropped from WBL. Advisors:

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Page 1: WBL JP Student Referral Form

Student Referral FormJob Placement/Work-based Learning

Advisors:

1. The student referral form should be submitted to the WBL/JP office or mailbox by the student’s advisor. Your candid feedback is valued and needed to ensure students/graduates receive appropriate JP/WBL assistance. (Form revised per input from team of 21 human resource specialists 8/16/11.)

3. If you are referring a student for WBL enrollment, stress to the student it is important to contact the WBL staff for class requirements. Students not meeting WBL requirements will be dropped from WBL. Below are listed employability skills employers have identified as critical for success in the workplace. Please rate ________________________________________________________ so the WBL/JP staff may properly assist him/her. (Student name)

Rate 1 – 5 (1=Poor, 2=Needs Improvement, 3=Average, 4=Above Average, 5=Exceptional)

Note: Drug and Alcohol abuse are not listed for you to rate, but as you know, negatively impact employment.

Comments:

_______________________________________ _____________________________________ ____________

Advisor Signature Student’s Major Date

Attendance 1 2 3 4 5 Interpersonal Relations 1 2 3 4 5

Punctuality 1 2 3 4 5 Quality of Work 1 2 3 4 5

Respects Authority 1 2 3 4 5 Accepts Criticism 1 2 3 4 5

Positive Attitude 1 2 3 4 5 Use of Technology 1 2 3 4 5

Follows Instructions 1 2 3 4 5 Academic Aptitude 1 2 3 4 5

Safety 1 2 3 4 5 Thinking Skills 1 2 3 4 5

Adaptability 1 2 3 4 5 Communication Skills 1 2 3 4 5

Dependability 1 2 3 4 5 Professional Image 1 2 3 4 5

Attention to Detail

Embraces Diversity

Proper Grammar

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Character

Takes Initiative

Team Player

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

Positive Attitude 1 2 3 4 5