Work Verification Form

1. Student Name *

Please include your first, middle and last name.

2. Today's Date *

Month

Day

Year

Is this an original submission or a resubmission? *

Original Submission

Resubmission

3. 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 *

Other Year

Identify year if not available in field above.

4. Total Hours worked during the period noted above *

5. Student's Email *

Must be an @purdue email address.

6. Student's Phone Number *

7. Academic Advisor *

Danielle Gilbert

Brenda Barrera

Kimberly Vi

Harley Barta (Graduate Students)

8. Student Classification *

9. Did you work in an office or on a jobsite? *

Office

Jobsite

Both

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

Examples: Jobsite cleanup, site layout, solicited sub bids, posted RFI, daily reports, assisted in estimating, etc...

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

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

13. Has this work experience changed your mind about which sector of the construction industry you might be most interested in pursuing? If yes, please explain. *

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