SVSTI Placement Attestation

SVSTI

Student Placement Attestation Form
I, First Name* Last Name* attest that the training I have received in the * program was beneficial in obtaining the position of Job Title* at Place of Employment*.
Did you get a job in your program of study? *

Yes No
My new or current position is a paid job that meets my employment goal through:

Full time, permanent work for a single employer (defined more than 29 hours per week) Part time, permanent work for a single employer (defined as less than 29 hours per week)
IF PART-TIME, did you choose part-time to fit your schedule or was it because you could not find full-time work?

Wanted part-time Could not find full-time
Employer *
Hourly Wage *
Employer Contact Name *
Employer Contact Email *
example@example.com
Employer Contact Phone Number
Employment Start Date *

Month Day Year
Date
If a position has not been obtained in the program of study, please select the reason:

Health Reasons Incarceration Military Death Continued Education
Did you take the Certification exam? *
If yes, which one?

CBSPD IAHCSMM NBSTSA
Did you pass the Certification Exam?

Yes No
Did you pass on the 1st attempt?

Yes No
By completing and signing this form you agree with the information provided.
Name *

First Name Last Name
Signature *

Clear
Today's Date *

Month Day Year
Date
Email
example@example.com
Should be Empty: