JOB DESCRIPTION FORM
                Murray State University                              FOR COOPERATIVE EDUCATION
                            210 Ordway Hall
                            Murray, KY 42071
                            Phone: (270) 809-3117 Fax: (270) 809-3516

TO BE COMPLETED BY STUDENT:

        Student Name_______________________________________________ M #_______________________

        Current Address__________________________ City____________________State_____Zip__________

        Current Phone____________________________Cell/Pager No.__________________________________

        E-mail______________________________Work Period (Circle one)         Fall            Spring            Summer

        Address During Work Period (if different from above)___________________________________________

        Student Signature__________________________________________Date__________________________

TO BE COMPLETED BY EMPLOYER:

        Company/Organization Name_______________________________________________________________

        Mailing Address______________________________City__________________State______Zip_________

        Phone__________________________Fax_________________________Pager No.____________________

        Supervisor Name_____________________________________Title________________________________

        Supervisor Email_____________________________________Department__________________________

        Website Address_______________________________Phone(if different from above)__________________

        Students Title (postion on the job)____________________________________________________________

        Average number of hours student will work per week_________Salary/Wage/Commission___________________

        Starting Date____________________Finish Date______________________Total No. of Weeks___________

        Employer Signature____________________________________________Date_______________________

In order for a student to receive a passing grade for a cooperative education experience, the student must remain on
the job for the entire period assigned and perform to a satisfactory level all duties and work assignments given by the
employer and/or faculty advisor.

PLEASE ATTACH A DETAILED JOB DESCRIPTION

Murray State University is an equal education and employment opportunity, M/F/D,AA employer.