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Placement Form

Please fill all the fields of placement information below (Fields marked with * are mandatory)

Student ID# *

LoLA ID#

Student Last Name *

Student First Name *

Program *

Program Student is/was enrolled.

Employer Name

Emp Address

Emp City

Emp State

Emp Zip

Emp Phone

Rate of Pay

Hours Per Week

The training I received at SOWELA is related to my current job *

Reason Not Employed

None Given
Focusing on College Studies
Unavailable for Employment
Other

Full-time Military (Give Branch and Date Active Duty Initiated)

Only enter if joined the military