Work Verification Form

1. Name (Please provide your first, middle and last name.)

First Name *

Middle Initial

Last Name *

2. PUID Number *

3. Today's Date *

Month

Day

Year

4. Work Period Included in this Form

Please provide the month of your start and end dates. NOTE: One internship and one company per form. If you worked for two companies, each for five weeks over the period of one summer - you need two forms.

Start Month *

Start Year *

End Month *

End Year *

5. Total Hours worked during the period noted above *

6. Student's Email *

Must be an @purdue email address.

7. Student's Phone Number *

8. Student's CGT Major *

Select all that apply.

9. Academic Advisor/Instructor *

10. Student Classification *

Freshman

Sophomore

Junior

Senior

11. List five activities that you regularly performed during this period *

Examples: updating employee records, sales, supply chain analysis, onboarding activities, daily reports, assisted in interviewing, etc...

12. Explain how your work experience related to material presented in the classroom *

13. Is there anything you wanted to do, learn or experience during this work experience that you were not able to? *

14. Has this work experience changed your mind about working in your major or a specialty within it? If yes, please explain. *

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