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Queensborough Community College The Office of Career Services Library Building, Room 429 & 430 222-05 56th Avenue Bayside, NY 11364 Phone: (718) 631-6297

Congratulations on securing a work experience, e.g. internship, co-op, job. We hope you are excited and looking forward to getting started.

We invite you to visit the Office of Career Services to discuss your work experience and placement with a staff member.

Learning about your success is the best part of our job. Please complete the information below to the best of your knowledge and submit this report to our office (click submit button below). Your cooperation is greatly appreciated.

Thank you and best wishes in your new endeavor.

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Student's Name:*
Curriculum:*	--Select a Curriculum-- Anthropology Art History Astronomy Biological Sciences Business Law Business Management Chemistry Chemistry and the arts Chemistry and the environment Cinema and Film Commercial Art Computer Programming Computer Science Dance Economics Education EKG Technology Emergency Medical Training English as a Second Language Environmental Health Environmental Science Fiber Optics French Geology German Graphic Art Healing Arts Health Sciences Hebrew Holistic Health Insurance Italian Laser & Fiber Optics Literature Marketing Massage Therapy Massage Therapy:Healing Arts Mathematics Medical Laboratory Medical Office Assistant Nursing Nursing Chemistry Office Skills Pharmacology Philosophy Phlebotomy Photography Physics Poetry Political Science & Government Psychology Real Estate Religion Sociology Spanish Speech Sports Studio Arts Team Sports & Combatives Theater Urban Studies
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State:*	--Select a State-- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
Zip:*
Home Phone Number (xxx-xxx-xxxx):
Work Phone Number (xxx-xxx-xxxx):
E-Mail:*
Employer Name:*
Employer Address:
Immediate Supervisor:
Supervisor's Title:
Supervisor's Phone (xxx-xxx-xxxx):
Department or Work Area:*
Job Title:*
Work hours per week:
Type of position:*	--Select Position Type-- Internship Cooperative Education Full-time Part-time Summer Employment Temporary Employment Volunteer Work Other
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