Name of Firm definition

Name of Firm. By: _______________________________________________________________________ Print Name & Title: _______________________________________________________ Date: __________________________ NASD CRD Number __________________________

Name of Firm. Supervisor: Address: Phone: City: Zip: Worker’s Disability Carrier: Policy No. Liability Insurance Carrier: Policy No. Job Title: Date Employment Begins: Ends: Hours to be worked: Mon Tue Wed Thu Fri Sat Sun Earliest Latest Avg. Hrs. Per Day*: Xxx Xxx. Per Week**: Starting Wage: *Cannot compute to more than ½ of the pupil’s FTE. **Work and school hours cannot exceed 48 hours per week for students under age 18 IMPORTANT: IN-DISTRICT placements MUST be directly related to one of the following: 🞏 State-Approved CTE work-based (Name of related CTE Program: ) PSN from above: 🞏 Postsecondary career and employment goals and objectives in the pupil’s transition service plan developed for special education services. A copy of the pupil’s transition services plan must be attached and relate directly to placement. Failure to do so will result in lost FTE. Position/Assignment: Supervisor: Beginning Date: Ending Date: This assignment is: (check one) 🞏 for the marking period 🞏 for the semester 🞏 for the school year Hours to be worked (must occur during scheduled classroom time): Mon Tue Wed Thu Fri Education/Career Goal(s): List the education goals related to this placement that aligns with the student’s career pathway contained in the student’s educational development plan. For unpaid work-based experiences, specific, unduplicated skills must be listed for each 45 hours of placement. *Attach copy of the EDP or IEP.

Name of Firm. Address: Phone:

Examples of Name of Firm in a sentence

• Proposed Position: Name of Firm: Name of Staff: Profession: Date of Birth: Years with Firm: Nationality: Membership in Professional Societies: Detailed Tasks Assigned: Key Qualifications: [Give an outline of staff member’s experience and training most pertinent to tasks on assignment.

• Support StaffTPF – 5: Format of Curriculum Vitae (CV) for Proposed Professional Staff Proposed Position: Name of Firm: Name of Staff: Profession: Date of Birth: Years with Firm/Entity: Nationality: Membership in Professional Societies: Detailed Tasks Assigned: Key Qualifications:[Give an outline of staff member’s experience and training most pertinent to tasks on assignment.

• Name of Firm Address of Firm Contact Person Telephone # Fax #( ) ( ) Name or Contract No. # of Years / Term of Contract Type of Service Dollar Amt.

• If a joint venture, appropriate officers of each company shall sign.) (Signature of Chief Executive Officer) (Typed Name and Title) (Type Name of Firm) Dated: APPENDIX C PAYMENT CONDITIONS AND RATE SCHEDULES 1.

• Name of Firm Signature of Bidder over Printed Name Address & Tel.

More Definitions of Name of Firm

Name of Firm. Address: Phone: Contact person for matters concerning MBE/WBE compliance:

Name of Firm. Begin: End: Supervisor: Phone:

Name of Firm. Begin: End: Supervisor: Phone: Address: : State: Zip:

Name of Firm. By: ____________________________________ Title: _________________________________ Address: _______________________________

Name of Firm. Dated this: Day of Printed Name Title Signature

Name of Firm. Firm’s Principal Office Address:

Name of Firm. Password: Participant’s Name: (Please create minimum 2 (Broker) maximum 10 combination of letters and numbers)