Preliminary Report
*Complete this form within ONE WEEK of reporting to work and return to the Career Center.
Job Duties:
A B C D
Address
Last Name First Name Middle Initial
SOPH JR SR Graduate
Student
Present
Address
Major
City/State/
Zip Code
T Number
Employer
City/State/
Zip Code
Supervisor
Name and Title
Supervisor
Work #:
Supervisor
Email:
Class
Status
Work
Hours
Days Per
Week
Hourly
Salary
Date
Returning
to School
Co-op
Plan
Name
(Print)
Phone #
Center for Career Development
Box 5021 Cookeville, TN 38505
Phone (931) 372-3296 Fax (931) 372-6154
http://www.tntech.edu/career career@tntech.edu
Month/Year
Expected Graduation Date
Month/Year
Email
Address
Start
Date: