Employers - Job Information Form - (Complete, print, and mail completed form)

Students with jobs should complete the following:

1. Receive an Approval from the Co-op Coordinator.
2. Enter your Demographics in PlacePro at www.coop.eku.edu.
3. Complete the Online Orientation.
4. JOB INFORMATION completed and signed by employer and approved by Coordiantor.
5. Come to the Co-op Office (SSB, 4th Floor, Rm #455) with this completed and approved to complete the registration process (Can be faxed to: 859-622-1300). You may also mail form to:
   Cooperative Education
   Eastern Kentucky University
   455 SSB, CPO 61
   521 Lancaster Ave.
   Richmond, KY 40475-3161

Note: You must work the entire semester to earn Co-op credit. DO NOT QUIT your job prior to the end of the semester.

  will Co-op with 
                Student Name                                                                                         Company Name

  to     during the semester.
              Start Date                                                  Finish Date                                                      (Spring, Summer, Fall)

Company Address:

City:        State:        Zip Code:        

Phone: ( ) -         Fax: ( ) -

Hourly Salary:  $    Hrs. working per week:  

Co-op Job Title :

Detailed Job Description:

Supervisor Signature:       Title:  

Supervisor Name:       E-Mail:  
(Please Print)

This agreement is valid if you retain the student multiple semesters. Please feel free to contact us at 859-622-1296

Major     Credit Hours

Job duties approved       Need additional duties related to major

Faculty Coordinator:      Date: / /