Application Procedure

West Salem High School

Industrial Technology Career Academy

  1. Complete the attached application.
  2. Type applicant essay on a separate piece of paper; include your name on the essay. Attach the essay to your application. This essay is very important. Explain what your passions are and what you want to do when you graduate from high school. Take the time, and have someone proofread it for you!!
  3. Obtain three (3) recommendations using the attached recommendation forms.
  4. One (1st) recommendation should be from school personnel such as a teacher, counselor, coach or advisor.
  5. Second (2nd) recommendation should be from an adult outside of school such as an employer or someone who can attest to your work.
  6. Third (3rd) recommendation can be from an adult of our choice, but not a relative.

Submit all application materials to Mr. Liethen by May 2nd 2016

(Applications can be dropped off at the WSHS Office)

Required attendance

  1. Student will be asked to attend an informational meeting on May 10th at 7:00 PM at the West Salem High School Automotive Lab. Interviews will be conducted by Academy Staff after the May 10th meeting to determine which students will be allowed to attend the academy.
  2. Students must attend weekly evening classes
  3. One night (7:00 -10:00) during the school year (Tuesday is Automotive Thursday is Diesel).
  4. Special field trips and Job Shadow opportunities arranged by Academy Staff.

Student Application Form

Background Information

Applicant Name ______Birth Date ______

LastFirstMiddle InitialMonthDayYear

Address ______

Street or PO BoxCityStateZip Code

Cell Phone Number (_____)______Home Phone Number (____)______

Area of interest (please circle one): AutomotiveDiesel

Please list the following information to assist us in evaluating your application for the Career Academy Youth Apprenticeship program. Use a separate piece of paper if necessary.

A. Work Experiences, Special Training Programs, and Related Educational Coursework

______

Activity or EmployerDate

______

Activity or EmployerDate

______

Activity or EmployerDate

______

Activity or EmployerDate

B. Responsibilities or obligations after normal school hours

(i.e. extra-curricular activities, work, family/child care, community activities, etc.)

______

ResponsibilityDate

______

ResponsibilityDate

Applicant Essay

On a separate piece of paper, please explain why you are applying to the Academy, and why you think you should be selected. List any volunteer, community service activities, and honors or awards you have received. Explain any relevant automotive or diesel experience or training that you have. Do not exceed two typewritten pages.

Parent/Guardian Information (to be completed by the applicant’s parent/guardian)

Parent/Guardian’s Name ______

LastFirstMiddle Initial

Address ______

Street or PO BoxCityStateZip Code

Home Phone Number (_____)______Daytime Phone Number (_____)______

Why would your child be a good candidate for this youth apprenticeship program and how are you willing to support your child’s involvement in this program? (Use a separate piece of paper if necessary).

Transcript

Please attach your high school transcripts to your application. Employers may require additional information. Transcripts are available from the student services office. Please do not wait until the last minute to get transcripts. Allow at least a week.

Certification

Please sign and date this application.

“I certify that the facts contained in this application are true and complete to the best of my knowledge and that this applicant has not been adjudged delinquent for behavior that would constitute a violation of criminal law in an adult court.”

Applicant Signature ______Date ______

Parent/Guardian Signature ______Date ______

Recommendation 1

Student Name ______

School ______Year of Graduation______

Personal Work Habits
(how person approaches daily obligations) / Excellent / Above
Average / Average / Below
Average / Poor
Takes responsibility
Displays positive attitude
Maintains effort
Reliability
Communication Skills
(written, verbal, listening)

Please provide any additional explanation of ratings above.

Please provide any other comments that will indicate your estimation of this student’s potential success as an employee:

Return this form to:

Paul Liethen

West Salem High School

490 North Mark Street
West Salem, WI 54669
608-786-1220 Ext. 2402
Cell: 608-397-5413

______

Name of EvaluatorTitle

______

CompanyPhone

______

SignatureDate

Recommendation 2

Student Name ______

School ______Year of Graduation______

Personal Work Habits
(how person approaches daily obligations) / Excellent / Above
Average / Average / Below
Average / Poor
Takes responsibility
Displays positive attitude
Maintains effort
Reliability
Communication Skills
(written, verbal, listening)

Please provide any additional explanation of ratings above.

Please provide any other comments that will indicate your estimation of this student’s potential success as an employee:

Return this form to:

Paul Liethen

West Salem High School

490 North Mark Street
West Salem, WI 54669
608-786-1220 Ext. 2402
Cell: 608-397-5413

______

Name of EvaluatorTitle

______

CompanyPhone

______

SignatureDate

Recommendation 3

Student Name ______

School ______Year of Graduation______

Personal Work Habits
(how person approaches daily obligations) / Excellent / Above
Average / Average / Below
Average / Poor
Takes responsibility
Displays positive attitude
Maintains effort
Reliability
Communication Skills
(written, verbal, listening)

Please provide any additional explanation of ratings above.

Please provide any other comments that will indicate your estimation of this student’s potential success as an employee:

Return this form to:

Paul Liethen

West Salem High School

490 North Mark Street
West Salem, WI 54669
608-786-1220 Ext. 2402
Cell: 608-397-5413

______

Name of EvaluatorTitle

______

CompanyPhone

______

SignatureDate