Own Placement Form
Own Placement Form
Section 1: Applicant Information (Completed by student) / Type Here Type Here Type HereStudent ID: Type Here / First Name:Type Here / Surname:Type Here
Course: Type Here / Major Option (if applicable): Type Here
Mobile Number: Type Here / Split Placement: Choose an item.
Please ensure that you submit all material requested in Section 3.
Student Signature:Type here in lieu of signature / Date: Click or tap to enter a date.
Section 2: Employer Information (Completed by Employer – all fields are compulsory)
Name of Employer/Organisation: Type Here
Address: Type Here / Website Address: Type Here
Contact Person: Type Here / Position in the company: Type Here
Telephone Number: Type Here / Email Address: Type Here
Does this placement involve the student having access to children or vulnerable adults?Choose an item.
If Yes, the student will be vetted through the University of Limerick Garda Vetting process.
Start Date: Click or tap to enter a date. / End Date: Click or tap to enter a date.
Rate of Pay: Type Here
Please provide the student with a signed letter, on company letterhead, outlining the student duties and specifying the commencement and termination dates of employment.
Employer Signature:Type here in lieu of signature / Date: Click or tap to enter a date.
Section 3: Submission Instructions For Student / Submission Check List
You must attach the following when submiting this form to the Cooperative Education & Careers Division
- a letter, on company letterhead, signed by your employer, outlining your duties and specifying your commencement and termination date of employment.
- Provide the placement description details requested on page 2.
Please note: Cooperative Education staff members are not involved in your ID verification process.
Failure to supply all the information requested will result in your placement not being recorded in your transcript, and subsequent failure of Cooperative Education.At the end of your placement an Evaluation Form is issued to your employer to assess your performance. This form is returned to the College by the employer and is used in assessing your overall grade for Cooperative Education. / (Completed by student)
☐Completed Own Placement Form, Pages 1 and 2
☐Employer Letter
Section 4: University of Limerick Verification
Date:Click or tap to enter a date. / Tel. Call/Email: Type Here / Decision:Type Here
Cooperative Education Signature: ______
Placement Description (Completed by student)
Description of company
Click or tap here to enter text.
Description of Placement
Click or tap here to enter text.
Relevance of placement duties to course or personal development
Click or tap here to enter text.
Relevance of course modules to placement
Click or tap here to enter text.
Relevance of placement to career objective
Click or tap here to enter text.
Document Reference / QF002 / Revision No. / 5 / Date / 09/07/2018 / Page / 1 of 2