San Diego Community College District • 3375 Camino del Rio South • San Diego CA 92108-3883
WORK EXPERIENCE AND INTERNSHIP PROPOSAL - Page 2
Period of Employment: From To Semester units of credit received
I hereby certify that I will not claim credit for any other activities undertaken during the period
covered by this Proposal, except for those credits which may be allowed for the Work
Experience Project itself, and that the organization or business enterprise in which I will be
employed is not self-owned or self-operated.
APPLICANT SIGNATURE: DATE:
AFTER WORK EXPERIENCE HAS BEEN COMPLETED
FACULTY MEMBER: Please note that the following must be an ORIGINAL or DIGITAL signature from your
employer, so be sure to take this form with you during your Work Experience. Faxed copies are not acceptable.
VERIFICATION OF WORK EXPERIENCE PROJECT
THIS IS TO CERTIFY THAT
WAS EMPLOYED BY US FROM ______________ TO _______________
FOR ____________ HOURS PER DAY, ____________ DAYS PER WEEK
AND THAT THE NATURE OF THIS EMPLOYMENT WAS AS REPRESENTED ABOVE.
SIGNATURE: TITLE: DATE:
Page 2 of 2 - 10/20
Click in the signature field above to sign digitally (or configure a new digital ID if signing for the first time.)
PLEASE DO NOT use the "Sign" (Pen Nib) tool above to initial, draw, or place your digital signature on the signature line.
(Make a copy of PAGE 1 to serve as the employer certification which must be attached to the completion report.)
Employer: Click in the signature field above to sign digitally (or configure a new digital ID if signing for the first time.)
PLEASE DO NOT use the "Sign" (Pen Nib) tool above to initial, draw, or place your digital signature on the signature line.
Please use Adobe Reader or Acrobat Pro ONLY available here to fill out this form digitally. (Mac users, please DO NOT use Preview.)
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