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?*

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

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

Health ReasonsIncarcerationMilitaryDeathContinued Education
Did you take the Certification exam?*
If yes, which one?

CBSPDHSPAIAHCSMMNBSTSA
Did you pass the Certification Exam?

YesNo
Did you pass on the 1st attempt?

YesNo
By completing and signing this form you agree with the information provided.
Name*

First NameLast Name
Signature*

Clear
Today's Date*

MonthDayYear
Date
Email
example@example.com
Should be Empty: