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Your employment information is very important to us at Albany Technical College.

Please complete this form and return it to Career Services.

For placement assistance contact:

Mrs. Judy Jimmerson at 430-3514,

Mrs. Julie Pettway at 430-0516 or Mrs. Sandra Sutton at 430-3939

Name:*

 

Student ID #:*

Address:*

 

City:*

State:*
  Zip Code:*

Phone #:*

 

Last Term Attended:*

Will Not/Did Not Return Term:


Select ONE in EACH category below

Termination Status



Reason for Leaving Program



Employment Status












Program:

 

Campus:

Left with Employable Skills?




Grads/Completer's Employment Information:

Employer:

 

Job Title:

Address:

 

City:

State:
  Zip Code:

Continued Ed (College):

 

Program:


Form Completed by:




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