/

School of Kinesiology

Co-op Program

Supplemental Application

/ Office Use Only
Office
Employer
Student
CPR/First Aid
Local Only

Work Term Experience Sought (List 3 in priority order)

/

Desired Work Site (if known)

Other possible Work Site

General Information

Surname

/ Given Name(s) / Student #
Address until / No.Street

CityProvince/StatePostal Code

/ Tel.
E-mail
Permanent Address
(if different
from above) / No.Street

CityProvince/StatePostal Code

/ Tel.
E-mail
Are you legally eligible to accept employment in Canada?
Yes No / Have you ever completed a Police Record Check ?
Yes No
Current position in program.
2nd year
3rd year / Would you consider a co-op work site outside of Thunder Bay?
Yes No / Expiration Date of Standard First Aid Certificate / Expiration Date of CPR (C) Certificate
Education
Post Secondary or other institutions attended. Begin with most recent. /
Faculty, Department,
Division, or School
/
Discipline or
Program (Major)
/
Degree/Diploma/
Certificate
/
Date obtained or expected
Current Kinesiology course cumulative average
Overall academic average for all courses taken to date
Highlight skills relevant to the position(s) sought.
Educational Experiences and Accomplishments
Describe your relevant courses, project work, theses, publications, and presentations. Include any awards and/or scholarships.
Extracurricular Activities
Describe your extracurricular activities including class or campus offices held, volunteer experience, memberships in clubs or organizations,
leadership roles, sports activities, hobbies, etc. (You are not required to mention the names of organizations that indicate race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status, political beliefs or disabilities).
Work/Placement Experience
Describe all work/placement experience (paid and/or unpaid) starting with most recent.
PositionName of Organization
CityProvince/StateDates
Duties: / Summer
Part-time
(# of hours/wk )
Co-op
Internship
Volunteer
Full-time
Other: (specify)
PositionName of Organization
CityProvince/StateDates
Duties: / Summer
Part-time
(# of hours/wk )
Co-op
Internship
Volunteer
Full-time
Other: (specify)
PositionName of Organization
CityProvince/StateDates
Duties: / Summer
Part-time
(# of hours/wk )
Co-op
Internship
Volunteer
Full-time
Other: (specify)
PositionName of Organization
CityProvince/StateDates
Duties: / Summer
Part-time
(# of hours/wk )
Co-op
Internship
Volunteer
Full-time
Other: (specify)
Summary
Demonstrate your suitability for position(s) sought, by outlining your career objectives and elaborating on the factual material already presented. Show how your experience (educational, extracurricular and work) is relevant to the position(s), organization, and/or field of work for which you are applying.
Since enrollment in the co-op program is limited, applicants may be asked to appear for an interview with the admissions committee. Please submit all information to the following representative by November 30:
Co-op & Employer Relations Officer
Student Success Centre
Lakehead University –SC 0017B

I wish to be considered for entry into the Honours Bachelor of Kinesiology Co-op Degree program and for work term placement in the Spring/Summer term of this academic year and realize that an Admission Agreement will be need to be submitted with my signature after being accepted into the program. If accepted, I will attend meetings, meet deadlines and make arrangement to pay the Co-op Participation Fee(s) in accordance with the Co-op program as detailed in the Calendar. I will also submit the following four items to the Co-op and Employer Relations Officer (for evaluation by the Kinesiology Co-op Advisor) by the end of each four month work term:
  • Admission Agreement Form -
  • Work Term Report
  • Work Term Report Evaluation
______

DateSignature