Chabot College
CalWORKs
Student Name________________________________
Check List
Note: Please organize your documents in the order below. All requested documents must be completed
before submitting it to the CalWORKs Office. Incomplete applications will not be considered.
Student Initials
1 _________
Documents in the Package
Student Assistant Employment Packet
__________
Plan B
__________
2 _________
Student Work Study Contract
4 _________
Form W-4
3 _________
5 _________
6 _________
7 _________
Form I-9 (Employment Eligibility)
Tuberculosis Test (TB Test)
Additional Documents You Must Attached
__________
__________
__________
__________
CA ID or California Driver’s License
__________
Permanent Resident Card (if applicable)
__________
8 _________
Social Security Card
10 _________
Resume (If available. Employment Coordinator will help create if needed)
9 _________
Staff Initials
Other forms of identifications may be accepted. Please
refer to form I-9.
__________
__________
Student Work Study Contract
Student Name: ______________________________
1. Attendance and Office Etiquette:
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Punctuality: Arrive on time
Check-in and out each day with supervisor
Inform a staff member when you leave the office (i.e. class, restroom, break)
Stick to the schedule you agreed to with your supervisor
Call the office ahead of time when you are unable to report to work on any assigned day
Wear appropriate attire as required by work site and the Chabot CalWORKs office
2. Duties and Expectations:
 Be responsible for duties assigned to you
 Ask staff member for a new assignment once you are finished with a task
3. Conduct and Other Reminders:
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Be courteous and respectful at all times
Work cooperatively with staff and other student workers
Limit using your cell phone/texting while at work
Adhere to office rules
Meet all needs of the office as specified
4. Causes of Termination:
 Insubordination including, but not limited to, refusal to do assigned work
 Repeated tardiness/ absences, unreported and/or unauthorized absences
 Discourteous, offensive, or abusive conduct or language toward other employees, students, or
the public
 Dishonesty, including the unauthorized use or removal of employers property out of the office or
premises
 Drinking alcoholic beverages on the job or reporting to work while intoxicated
 Use or possession of narcotics on the job
 Use or possession of firearm on the job
 Abandonment of position
 If you become ineligible or have been sanctioned by Alameda County
 When your enrollment status falls below one unit
__________________________
___________________
__________________________
___________________
Student Signature
Employment Coordinator Signature
Date
Date
CalWORKs Work Study – Plan B
TRANSPORTATION
I will get to work/class primarily by _______________. My commute will probably take about ________
minutes each day.
Plan B: If this does not work, I will get to work/class by _____________. This way will probably take me
about ________ minutes to get where I need to be.
If Plan does not work out, please call your instructor/supervisor at least 1 hour before scheduled class/
work
Child Care
While I am at work/class, my children will be at _____________________________.
Plan B: If that is unavailable, my children can go to _____________________________ instead.
If Plan B does not work out, please call your instructor/supervisor at least 1 hour before scheduled
class/work.
Housing
I live in/with _____________________________ and project to stay there for at least several months.
Plan B: If I get evicted or have other concerns, I can stay temporarily with/at
_____________________________.
If Plan B does not work out, please call your instructor/supervisor at least 1 hour before scheduled
class/work.
CLASS/WORK
Students are solely responsible in contacting your instructor/supervisor at least an hour before activity
to let him/her know you are running late or you will not be able to attend class/work.
Plan B: If I cannot reach my instructor/supervisor, I will _____________________________.
Note: If you are not attending class that day, you will not be able to attend your work study assignment
_____________________________________________________________________________________
I, _____________________________, am solely responsible for contacting my instructor/supervisor and
not the CalWORKs Office. Any failure to communicate with an instructor/supervisor can result in a
drop/termination.
__________________________
___________________
__________________________
___________________
Student Signature
Employment Coordinator Signature
Date
Date