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CooperativeEducationProgram
EmployerInformation&Agreement
Bristol-PlymouthRegionalTechnicalSchool207HartStreet|Taunton,MA02780
Telephone:508-823-5151ext.130 Fax:774-299-6355 Email:[email protected]
COOPERATIVEEDUCATIONAGREEMENT
EmployerName:_______________________________________________________________________________
Address:____________________________________________City:____________________State:___________
TheemployerisakeycomponentoftheCooperativeEducationProgram.Theeducationalopportunitiesthatemployersaffordourstudentsspeakvolumestotheircommitmenttoyouth,educationandcommunity.
FollowingareguidelinesforallemployersparticipatingintheCooperativeEducationProgramBristol-PlymouthRegionalTechnicalSchool:
· EnsuresworkenvironmentmeetshealthandsafetystandardsthatmaximizeemployeeprotectionincompliancewithOSHAregulations.
· EnforceworksitesafetyperOSHAregulations.· Provideorientation,includingsafetyandemergencypractices.· EnsureWorker’sCompensationcoveragefortheCo-opStudent.· Provideexperiencedsupervision.· ComplywithMassachusettsLegislativeActFurtherProtectingChildren(providingBristol-PlymouthRegional
TechnicalSchoolwithacompletedCORIform-BackgroundCheckonanyemployeewhowillbeone-on-onewithourstudents,alongwithacopyofthedriver’slicenseforeachperson).
· Complywithchildlaborlawsastheypertaintovocationalstudents.· AbidebyEqualOpportunitylaws/regulations/guidelines.· FollowallStateandFederallaborandwagelawsandregulations.· Providetheopportunityforthestudenttodeveloptechnicalandemployabilityskillsnotacquirablein
aschool-basedsetting,butacquirableinawork-basedsetting.· Provideaminimumof30hoursofmeaningfulemploymentperoneCo-opcycle.· NotifystudentandCooperativeEducationCoordinatorofanyproblemsorissues.· Immediatelynotifyschool/CooperativeEducationCoordinatorifstudentisinjuredandfilloutappropriate
paperwork.· Maynotemploystudentduringschoolhoursonhis/heracademiccycle.· NotifythestudentandCooperativeEducationCoordinator,inwriting,ifthisagreementneedsto
beterminated.· Haveallapplicabletaxesdeductedfromstudent’swagesandnotbehiredasindependentcontractors(1099)
Form.· Provideacopyofthecompany’sdocumentationofstudent’sworkhoursandgradestudentusingthegrading
sheetprovidedbytheschool.· AllowCooperativeEducationCoordinatorand/orTechnicalTeacherstoconductregularsitevisitsand/or
follow-upphonecallstoensurethattheagreementisbeingfollowed.
IMPORTANTNOTICE:Severaltradesforwhichcooperativeeducationareapplicablehavingbeendeclared“HazardousOccupations”forpersonslessthan18yearsofageandareregulatedbyFederaland/orStateStatute(whicheveristhemoststringentstandard).Inallsuchtrades,theworkofthestudentlearnershallbeincidentaltohisorhertraining,shallbeintermittentandforshortperiodsoftime,shallbeunderthedirectandclosesupervisionofaqualified
andexperiencedperson,andshallincludesafetyinstructionsbytheemployeraspartofthetraining.
Icertify,Ihavereadandaccepttheagreementsoutlinedabove.Ialsocertifythattheinformationprovidedistrueandcompletetothebestofmyknowledge.
_______________________________________________________________________________PrintNameofEmployerSignatureofEmployerDate
Theschool,employer,student,parent/guardianmayterminatethisagreementatanytimewithappropriatenoticeto
otherparties.Otherwisethisagreementexpiresuponhighschoolgraduationofthestudent.
COOPERATIVEEDUCATIONEMPLOYER
NameofEmployer:_____________________________________________________________________________AddressofEmployer:___________________________________________________________________________(Number)(Street)City/Town:____________________________________State:_________________ZipCode:________________ContactPerson:___________________________________________Title:_______________________________PhoneNumber:_____________________________FaxNumber:__________________________________EmailAddress:_________________________________________________________________________________NatureofEmployer’sBusiness:___________________________________________________________________NameoftheStudent’sSupervisor:_________________________________Title:___________________________PhoneNumber:_____________________________CellPhoneNumber:__________________________________EmailAddress:_________________________________________________________________________________StartDate:_______________________________________StartingWage:$______________________perhourNumberofqualified&experiencedworkersthestudentwillbeworkingwith:______________________________
WORKER’SCOMPENSATIONINSURANCEWorker’sCompensationPolicyNumber:____________________________________________________________
ExpirationDate:_______________________________________________________________________________
Pleasehaveyourinsuranceagent:
· Send(fax,emailormail)yourCertificateofLiabilitycontainingtheWorkersCompensationNumberalongwiththeexpirationdatetotheattentionoftheCooperativeEducationCoordinator.
· ListBristol-PlymouthRegionalTechnicalSchool|940CountyStreet|Taunton,MA02780asaCertificateHolder.
SAFETYTRAINING&SKILLSDEVELOPMENT
Pleasedescribethesafetytrainingthatthestudentwillreceivepriortobeginningwork.
______________________________________________________________________________________
______________________________________________________________________________________
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______________________________________________________________________________________Pleaselisttheknowledgeandskillsthestudentlearnerwillhavetheopportunitytoacquireandstrengthenwhileworkingforyourcompany.
1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
4. ______________________________________________________________________________________
5. ______________________________________________________________________________________
6. ______________________________________________________________________________________
7. ______________________________________________________________________________________
8. ______________________________________________________________________________________
9. ______________________________________________________________________________________
10. ______________________________________________________________________________________Pleaselisttheequipment,tools,ormachinesthatthestudentlearnerwillbeusingwhileworkingforyourcompany.
1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
3. ______________________________________________________________________________________
4. ______________________________________________________________________________________
5. ______________________________________________________________________________________
6. ______________________________________________________________________________________
7. ______________________________________________________________________________________
8. ______________________________________________________________________________________
9. ______________________________________________________________________________________
10. ______________________________________________________________________________________
HOURS&DAYSWORKING
StartTime:_____________________________________EndTime:_____________________________________
DaysWorking:(Checkalldaysthatapply)!Mon.!Tues.!Wed.!Thurs.!Fri.!Sat.!Sun.
Studentwillbeworkingafterschoolduringtheiracademicweek:!Yes!No
DaysWorkingAfterSchool:(Checkalldaysthatapply)!Mon.!Tues.!Wed.!Thurs.!Fri.!Sat.!Sun.
STATEMENTOFASSURANCEOFNON-DISCRIMINATION
______________________________________________________________________affirms(CompanyName)
thatitdoesnotdiscriminateonthebasisofrace,color,sex,genderidentity,religion,nationalorigin,orsexualorientationinregardstoworkingconditionsrelatedtohours,
wagesandbenefits.
_______________________________________________________________________(CooperatingEmployer) Mo/Day/Yr
COOPERATIVEEDUCATIONCRITERIONBristolPlymouthRegionalTechnicalSchoolisdedicatedtoprovidingCooperativeEducationopportunitiesandwillensureallofthefollowing:
· OnlystudentswhoareenrolledintheChapter74-approvedvocationaltechnicaleducationprogramwhohavedemonstratedtheacquisitionofknowledgeandskillsassociatedwithatleastoneandonehalfschoolyearsintheapplicableprogram,andinnocasewillitenrollstudentsearlierthanmidwaythroughtheirjunioryear.
· Studentsarecontinuouslysupervisedbyemployer.
· Studentsareprovidedcreditforcooperativeeducation.
· Awrittenagreementbetweentheschool,employer,student,andparent/guardiandelineatingknowledgeandskillstobeacquired,hours,wages,etc.isimplemented.
· Theemployeragreestomeetallapplicablerequirementsofstateandfederallaborlawsandregulationsincluding,butnotlimitedtoworkercompensationinsurance.
· Students/parents/guardiansarenotrequiredtowaivetheirlegalrightsasaconditionofparticipationincooperativeeducation.
· Asafetyinspectionoftheworksiteisconductedpriortostudentplacement.
· Allsafetyconcernsareremediatedpriortostudentplacement.
Our signatures certify that we have read and agree with the conditions outlined and contained in this agreement.
Employer:______________________________________________________ Date:______________
Parent/Guardian:________________________________________________ Date:______________
Student:________________________________________________________ Date:______________
Vocational Teacher:______________________________________________ Date:______________ Cooperative Education Coordinator:_________________________________ Date:______________