Fillable Advanced Maintenance Technician Co-op Application (Jackson State Community College)

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Advanced Maintenance Technician Co-op Application (Jackson State Community College)

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U.S.A. forms for Jackson State Community College

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Industrial Technology Program
Advanced Maintenance Technician Co-op Application
Personal Data: Please type or print legibly
Name _________________________________________________________________________________________________________________
First Middle Last
Street Address __________________________________________________________________________________________________________
City ___________________________________________________________ State ___________ Zip Code __________________________
Email _______________________________________________________ Home Phone _______________ Cell Phone ________________
Race/Ethnicity (Optional) _______________________________________ Gender: Male Female
Birth Month _______ Birth Day ___________
Are you a U.S. Citizen? Yes No Have you registered for the Selective Service? Yes No
Education: Transcript copies are required (unofficial) and should be attached at the end of this application.
High School Name ______________________________________ Guidance Counselor Name _________________________________________
High School Graduation Date or Expected High School Graduation Date: ___________________________
Number of students in graduating class: __________________
(Please see your guidance counselor to get an estimated number for your graduating class.)
Your rank based on your Quintile Ranking: Top 20% 2nd 20% 3rd 20% 4th 20% 5th 20%
(Please see your guidance counselor to get an estimated number for your graduating class.)
ACT Scores
English ________ Reading __________ Math __________ Science __________ Reasoning _________ Composite ___________
COMPASS Test Scores if applicable
Math __________ Reading __________ Writing ________
SAT Scores
Math _________ Critical Reading __________ Writing ___________ Composite ___________
High School Math Course (enter grade for all that apply):
Algebra 1 ________ Algebra 2 ________ Pre-Calculus _________ Calculus ________ Trigonometry _________ SAILS _________
List any other STEM (Science, Technology, Engineering, and Mathematics or Vocational) classes you have taken and the grade you received:
_______________________ __________________________ __________________________ __________________________
_______________________ __________________________ __________________________ __________________________
List any dual enrollment class or dual credits you have earned.
_______________________ __________________________ __________________________ __________________________
_______________________ __________________________ __________________________ __________________________
Education (continued)
List awards and honors received: ___________________________________________________________________________________________
______________________________________________________________________________________________________________________
List high school activities: ________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Additional information: Please initial each blank to indicate completion and understanding the following requirements.
Statements of validity and understanding:
Attached is a copy of my 500 word essay. (The essay should explain your interest in working as an Advanced Maintenance Technician
and your ultimate goal in applying for this educational program and company sponsorship. The essay should be 500 words, typed double
-spaced in a 12 point font.)
Along with this application and essay is a copy of my current high school transcript.
A JSCC College Admissions Application has been submitted to the Admissions Services Office at Jackson State.
If I am considered a qualified applicant, I understand I will be asked to participate in a formal interview with one or more consortium
member(s) and JSCC faculty/staff.
I give my permission to JSCC to share the information in this application as well as any documents I submit with businesses in the AMT
Consortium.
I certify that the above information is true and correct to the best of my knowledge. I am aware that falsifying or withholding information will lead
to invalidation of my application for the AMT Program.
If accepted into the AMT Program I am aware that I will be considered employment for any of the manufacturing consortium members and that the
decision where I will be placed will be made by the hiring committee and NOT by myself.
I understand and am prepared to meet employment screening requirements for the manufacturer where I am placed. I am aware that I will be required
to pass a drug screen and may have to complete a physical and/or have a criminal background check.
Print Name __________________________________________________________________
Applicant Signature ___________________________________________________________ Date ____________________________________
Jackson State Community College is accredited by the Commission on Colleges-Southern Association of Colleges and Schools to award degrees at the associate level.
Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097 or call 404-679-4500 for questions about the accreditation of Jackson State Community College.
http://www.sacscoc.org. TBR does not discriminate on the basis of race, color, national origin, sex, disability, or age. For inquiries regarding non-discrimination policies, contact equity@tbr.edu. IT17-6986
Work experience:
List any jobs, paid or unpaid, you have held in the past and a brief description of your responsibilities.
Job Responsibilities Dates Supervisor
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
List any skills or experiences, or certifications you feel will help you in the field of Industrial Technology.
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Please rate yourself 1-5 (5 being strongest) on the following statements:
_______ I like working with my hands. _________ I am a team player.
_______ I consider myself to be mechanically minded. _________ I am detail oriented.
_______ I enjoy problem solving and troubleshooting.
I have relatives that have worked in manufacturing. Y
N
Which type of work do you most prefer? Mechanical
or Robotic
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Advanced Maintenance Technician Co-op Application (Jackson State Community College)

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Completed 5 October 2020

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