*Employers should add JCPS Forms (noreply@please.signmyform.com) to their email contacts to ensure timely delivery and completion of all WBL forms.
Embedded Files
Employer Forms
Employer Forms
Completed by Employer
Only Required Once
Must Provide a Primary Contact Name and Email
Sent from JCPS Forms within Two Business Days after Registration
District Policy & State/Federal Regulations
Signed Annually by Primary Employer Contact
Required to Hire Eligible JCPS Students
Submitted by Student (Email from JCPS Forms)
Details of Work Experience
Verified by Work Supervisor (Name and Email Provided by Student)
Required to Permit Release from School
Submitted by School Staff (Email from JCPS Forms)
Evaluates Student Performance
Required by Kentucky Department of Education
Work Log Authorization (Unpaid Internships)
Submitted by School Staff (Email from JCPS Forms)
Verifies Accuracy of Student Work Logs
*Employers may be asked to complete additional forms based on the type of workplace experience.
Employer Expectations
Employer Expectations
Identify a point-of-contact person to be the primary contact for Work-Based Learning student placements.
Allow periodic site visits to ensure worksite compliance and student safety.
Maintain safe, healthy employment/worksite conditions.
Comply with all regulations prohibiting discrimination on the basis of race, color, national origin, sex, disabilities, religion, marital status or age.
Comply with all laws regarding wages and hours of minors and student learners.
Pay the student/trainee when an employer/employee agreement is negotiated.
Maintain confidentiality of student information in accordance with state and federal law.
Ensure paid student workers are covered by Worker’s Compensation Insurance and that the policy is now in force and registered with the Kentucky Department of Workers Claims as prescribed by KRS 342.630 (or with the appropriate agency, if the place of employment is outside of the state of Kentucky).
Ensure that supervising employee(s) have successfully completed a Kentucky state criminal background check within the past five (5) years.
*If supervisor background check is needed, contact Liz Adams, WBL Supervisor.
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