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Form Updated: 8/28/2020

Job Corps Student Loaner Device Program


Equipment and Usage Agreement
Intended for use by Job Corps student participants in the Job Corps Loaner Device Program.
Property of the Department of Labor WARNING: Theft of government property is a federal crime
under 18 U.S.C. section 641, and is subject to punishment by fine and/or imprisonment.
Center Name: Clearfield Job Corps Center
Center Property POC: SterlinegYeaman Phone: 801-416-4234

Student Name: Student ID:


Student Shipping Address:
City: State: Zip: Phone:

To participate in Job Corps online, you need a computer or tablet and the ability to connect to the internet. Initial each
item you need to participate online in Job Corps. Computer or Tablet Internet Connection
By signing this document, I agree to reimburse the center for lost or damaged equipment with total indebtedness not to
exceed $500. I understand that the center may seek reimbursement through pay period deductions against my personal
allowance not to exceed 50 percent per pay period. Any balance remaining at my time of separation may be deducted
from my transition payment. Please keep in mind at all times that this equipment is the property of the United States
Government.
I acknowledge that the device(s) is only to be used to participate in the Job Corps program. I will only use the device(s) to
connect to the internet and send and receive e-mail for Job Corps purposes or reasons. I will not allow others to use the
device(s). I must follow the Student Handbook’s rules on computer use and digital citizenship. Failure to follow Job
Corps' equipment and internet usage requirements may result in the immediate forfeiture of the equipment and could lead
to my removal from the Job Corps program.
I understand, and acknowledge, that:
1. Everything that I do on the loaner equipment is tracked and logged.
2. I have no expectation of privacy while using the loaner equipment.
3. I agree to retain this equipment for the duration of my enrollment with Job Corps. I will return equipment either
when I am asked to return it or depart the program.

Student Signature: Date:


Parent or Guardian Signature,
if Student is a Minor: Date:
Date Device(s)
Form Received by Center Staff: Shipped to Student:

Serial Number (Chromebook or equivalent computer equipment):


Hot Spot IMEI:
Other Digital Equipment Serial Number:

The following items have been returned: Computer/Tablet Hot Spot Other Digital Equipment
Student Signature: Date:
Parent or Guardian Signature,
If Student is a Minor: Date:

Equipment Received by Center Staff: Date:

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