Co-operative Education/Internship Program

REQUEST FOR REFERRALS

Department / Agency:  

Departmental acronym:  

Branch / section:  

Job number:  

Language requirements: Fr. / Eng. / Bil. / Either or

Work Term:

Starts (Y)  / / / / (M)  / / (D)  / /

Ends (Y)  / / / / (M)  / / (D)  / /

Job location:  

Is travel involved? Yes / No

Hours of work per week:  

Is overtime a normal requirement? Yes / No

Will department reimburse student for travel expenses to and from
educational institution? Yes / No

Supervisor's name:  

Telephone number: (         ) 

E-mail address:  

Facsimile number: (         )  

A. OPEN COMPETITION (Complete this section)

DEPARTMENTAL PARTICIPATION: Interview / On campus / Telephone
Other (please specify)  

STATEMENT OF SELECTION CRITERIA

This work term opportunity will be posted in the following educational institution(s):

1.  
2.  
3.  
4.  

No. of academic years required: University   College  

Academic field and specialization or specific courses required:
 
 
 
 

Other requirements and remarks (eg. security, medical, etc.):
 
 
 
 

Summary of duties (Available in both official languages):
 
 
 
 

B. RE-EMPLOYMENT (Complete this section)

Student's name:  

PRI:  / / 

Post-secondary institution:  

Previous work term: (Y)  / / / / (M)  / /

C. OPEN COMPETITION AND RE-EMPLOYMENT

Student should report to: (name, title, telephone no. and complete address)
 
 
 
 

Departmental Liaison Officer/Manager:
(name, telephone no. and mailing address)
 
 
 
 

Signature of authorized person:  

Date (Y-M-D) :  

THE PUBLIC SERVICE OF CANADA IS COMMITTED TO EMPLOYMENT EQUITY