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SAMAR STATE UNIVERSITY

         
           
         

Name of your College

       

SSU-ONJOB-FR-001

Supplementary Form

               

01-Aug -2017

Rev. 1

                 

Date

                         

DR. GIL O. AMOYAN Director, Industrial Linkages & Development Services Office This University

       

Sir:

                         

I have the honor to inform the office that I have taken the subjects reflected in the form shown

below in

order

to

finish

and

complete

the

academic

requirements under the

curriculum

during the

Semester,

school year

to

                         

In view of the fact that rating for all the subjects last taken prior to the OJT cannot be release by the officer of the University Registrar due to material time, I have sought the certification from my subject instructor/professors the status or conditions regarding the subjects taken and is evidenced in the accomplished form below.

Subject Taken

   

Instructor/Professor

 

Signature

Remarks

     
     
     
     
     
     
     
     
     
     

Very truly yours,

                     
           

(Name of Student OJT Applicant)

2

2 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

Recommendation Letter

Linkages and Development Services Recommendation Letter SSU-ONJOB-FR-002 01-Aug -2017 Rev. 1      
SSU-ONJOB-FR-002 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-002
01-Aug -2017
Rev. 1
               

Date

                     
             
             
             

Sir/Madam:

                   

Warm Greetings!

                 
 

,

a

yr. student of the university

and officially enrolled in the On-the-Job Training Program of the University under the

curriculum

School

major in year 20 – 20 , is hereby recommended

to undergo

hours of On-the-Job Training as a student-trainee in your

company/agency.

                 

Attached here are the complete sets of documents required by the University for submission upon entrance to the company or agency.

For a smooth and harmonious working relationship with your good office, I remain.

Very truly yours,

GIL O. AMOYAN, Ph.D. Director, Industrial Linkages & Development Services Office/ OJT Coordinator

Noted:

FELISA E. GOMBA, Ph.D. Vice President for Academic Affairs

1

1 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

the Director / Industrial Linkages and Development Services SSU-ONJOB-FR-003 01-Aug -2017 Rev. 1      
SSU-ONJOB-FR-003 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-003
01-Aug -2017
Rev. 1
     

STUDENT INTERNSHIP

                       
       

CURRICULUM VITAE

             

PERSONAL DATA

     
     

2”X 2” ID

                     
             

Father’s Name :

             

Mother’s Name :

             

Home Address :

                 

:

             

Nationality :

             

Languages :

             

Marital Status

:

       

Religion

:

         

NAME

           

CAREER OJT OBJECTIVE

   
       

DATE OF BIRTH

       
         
       

MOBILE NUMBER

           

EDUCATIONAL QUALIFICATIONS

   
                         
         

University

:

SAMAR STATE UNIVERSITY

 
       

E-MAIL

       

Course/Yr.

:

 
         

Major

:

 
       

UNIVERSITY

             

EXPERIENCE

     
       

Samar State University

       
       

UNIVERSITY ADDRESS Catbalogan City, Samar

       
       

WEBSITE

       
       

www.ssu.edu.ph

             

REFERENCES

     
       

PHONE (055) 251- 2139 / 251- 2016

           

Persons

 

Contact #

 
                   

GIL O. AMOYAN, Ph.D.

 

09176524763

 
       

AREA OF EXPERTISE

       

Director, ILDSO/ OJT Coordinator

       
 

     
 

           
 

     
       

PERSONAL SKILLS

                       
 

Highly motivated.

                       
 

Work well with others.

                       
 

Hardworking and diligent.

           
 

Active, full of life, vigorous, an

             

Signature over printed name

   
                             
   

energetic worker. Others:

       
                                   

3

3 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

the Director / Industrial Linkages and Development Services SSU-ONJOB-FR-004 01-Aug -2017 Rev. 1 ON-THE-JOB TRAINING
SSU-ONJOB-FR-004 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-004
01-Aug -2017
Rev. 1

ON-THE-JOB TRAINING AGREEMENT

 

1.

The Samar State University will permit

 
             

(Student-Trainee)

     
   

to enter this company/agency,

for

 
           

(Name of Company/agency)

     
   

getting knowledge and work experience as a student-trainee.

     
 

2.

The On-the-Job Training is to run for

hours with a minimum of

 
 

3.

hours per week in this company/agency. The student-trainee, while in the process of training, will have the status of an OJT or On-

 
 

4.

the-Job Trainee, neither displacing a regular worker now employed nor substituting for a worker in the company/agency. All complaints from arising from the On-the-Job training shall be addressed to and

 
 

5.

decided by the President of the University assisted by the Dean of the concerned college and the university OJT Coordinator. The parent or guardian shall be responsible for the personal conduct of the student-

 
 

6.

trainee while in the training with this company/agency. The university OJT Coordinator, in consultation with responsible persons in the

 
 

7.

company/agency, has the authority to transfer or withdraw the student-trainee from the training anytime, after deliberations of his/her case.

 
 

The acceptance of the student-trainee shall conform to all national, provincial and local laws and regulations.

Conformed:

 
 
   

Program Chair

       

Student-Trainee

     
   
   

Director, ILDSO/OJT Coordinator

     

Parent/Guardian

     
 

College Dean

Owner/Head of the Company/Agency

MARILYN D. CARDOSO, Ph.D. University President

4

4 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

the Director / Industrial Linkages and Development Services SSU-ONJOB-FR-005 01-Aug -2017 Rev. 1 STUDENT PLEDGE AND
SSU-ONJOB-FR-005 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-005
01-Aug -2017
Rev. 1

STUDENT PLEDGE AND WAIVER

                             
                                           
 

I,

,

     
 

years of age, and a student taking up in Samar State University, Catbalogan

   
 

City, Samar, hereby depose and say that:

                             
 

1.

I promise to obey and abide by all the rules and regulations promulgated and to be enforced

   
 

2.

in and by the Samar State University, it’s officials and other duly constituted authorities. The Samar State University, its teachers, officials, employees, agents, Coordinators and

   
 

3.

representatives shall not be liable for any accidents, harm or injury that may happen to me while in the performance of my duties and assignments as a student-trainee, the cause of which is, due to my neglect or failure to heed all the warnings, cautions, signs and/or advice and/or neglect to obey and abide by the rules and regulations prescribed and promulgated by the training officials and all other constituted authorities and further waive and renounce my right to claim for the damage from the Samar State University, its officials, coordinators, agents and representatives, for any accidents causing death above. I have read and fully understood the contents of this pledge and I affix my signature hereon freely and voluntarily.

   
   

IN WITNESS WHEREOF, I hereby sign my name this

day of

,

 
   

20

,

at Catbalogan City, Samar, Philippines.

                     
                                           
                     
                     

Student Name/Signature

       
           

PARENT’S OR GUARDIAN’S AGREEMENT

             
     

I,

,

of legal age, single/married and a

   
 

resident of

,

whose signature

   
 

appears below, have read and understood the contents of the foregoing pledge and waiver signed by my son/daughter/ward and hereby freely and voluntarily state that I agree with the concur on the same and without any qualifications or mental reservation.

   
     

I hereby certify to the correctness and accuracy of the above statements.

       
           
     

Date

         

Signature of Parent or Guardian

       
     

SUBSCRIBED AND SWORN TO before me this

,

day

of

,

   
 

20

affiant exhibiting to me his/her Residence Certificate

       
 

issued at

on

,

20

         
                                           
                         

Administering Officer

5

5 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

the Director / Industrial Linkages and Development Services SSU-ONJOB-FR-006 01-Aug -2017 Rev. 1 OJT WEEKLY
SSU-ONJOB-FR-006 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-006
01-Aug -2017
Rev. 1

OJT WEEKLY ACCOMPLISHMENT RECORD SHEET

       

Month

,

20

         
                             

Name of Trainee:

Curriculum & Year

 

Name of Establishment:

 

Address of Establishment:

 

Date

NATURE OF JOB OR SKILL PERFORMED

 

Hours

Employer’s Evaluation (please check the appropriate level of Performance)

 
                   

Poor

Very

Excellent

 
                   

Good

 

Week 1

                           
 
 
 
 
 
 
 
 
 
 

Week 2

 
 
 
 
 
 
 
 
 
 
 

I hereby certify that the above attachment are true and correct to the best of knowledge and belief.

 
           

Verified True and Correct:

     

Printed Name & signature of Trainee

 
             

Head of Agency/ On-site Supervisor

6

6 Republic of the Philippines SAMAR STATE UNIVERSITY Office of the Director / Industrial Linkages and

Republic of the Philippines

SAMAR STATE UNIVERSITY

Office of the Director / Industrial Linkages and Development Services

the Director / Industrial Linkages and Development Services SSU-ONJOB-FR-006 01-Aug -2017 Rev. 1 OJT WEEKLY
SSU-ONJOB-FR-006 01-Aug -2017 Rev. 1
SSU-ONJOB-FR-006
01-Aug -2017
Rev. 1

OJT WEEKLY ACCOMPLISHMENT RECORD SHEET

       

Month

,

20

         
                           

Name of Trainee:

Curriculum & Year

 

Name of Establishment:

 

Address of Establishment:

 

Date

NATURE OF JOB OR SKILL PERFORMED

 

Hours

Employer’s Evaluation (please check the appropriate level of Performance)

   
                 

Poor

Very

Excellent

 
                 

Good

 

Week 3

                         
   
   
   
   
   
   
   
   
   
   

Week 4

   
   
   
   
   
   
   
   
   
   
   

I hereby certify that the above attachment are true and correct to the best of knowledge and belief.

   
           

Verified True and Correct:

   

Printed Name & signature of Trainee

   
             

Head of Agency/ On-site Supervisor

7

7 SSU-ONJOB-FR-09 01-Aug -2017 Rev. 1 MEMORANDUM OF AGREEMENT KNOW ALL MEN BY THESE PRESENTS: This

SSU-ONJOB-FR-09

01-Aug -2017

Rev. 1

MEMORANDUM OF AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This MEMORANDUM OF AGREEMENT is made and entered into by and between:

Samar State University an educational institution duly recognized by the Commission on Higher Education (CHED) with office address at Catbalogan City, Samar herein represented by its present University President Dr. Marilyn D. Cardoso of legal age, Filipino with office address at Catbalogan City, Samar who is duly authorized to represent in this transaction herein after referred to as Samar State University (SSU);

and

     
       

(Name of Company/Agency/Corporation)

       

a company/Corporation/Agency/Establishment duly recognized at existing under

 

and by virtue of laws of the republic of the Philippines with business address at

 

the

 
       

(Address of Company/Agency/Corporation)

       

represented herein by

of legal age,

 

(Name of Authorized Representative / Head of agency)

 

Filipino who is duly authorized to represent in this transaction, herein after

 

referred to as the

;

   
       

(Name of Company/Agency/Corporation)

       
       

WITNESSETH:

       

WHEREAS, SAMAR STATE UNIVERSITY is offering engineering, arts and sciences, education, technical and technological courses wherein the students are required to undergo On-the-Job Training, practices or internship to promote quality education and given the opportunity to expose/apply their skills, knowledge and proper attitude, thereby augmenting their formal schooling. WHEREAS, SAMAR STATE UNIVERSITY, recognizes that the students shall undergo On-the-Job Training at company/corporation/agency/establishment which proposal is accepted by the latter subject to the terms and conditions provided for in this Memorandum of Agreement.

 

WHEREAS,

recognizes further that

 
       

(Name of Company/Agency/Corporation)

       

Industry-University collaboration has proved beneficial to the student, school and

company to develop prospective labor force according to company’s specifications

and at the same time serve as venue for the OJT/practicum/internship of college

students.

8

8 SSU-ONJOB-FR-09 01-Aug -2017 Rev. 1 NOW, THEREFORE , for and in consideration of the foregoing

SSU-ONJOB-FR-09

01-Aug -2017

Rev. 1

NOW, THEREFORE, for and in consideration of the foregoing premises; both

parties SAMAR STATE UNIVERISTY and

 
         

(Name of Company/Agency/Corporation)

 

do hereby agree and stipulate the following terms and conditions of this Memorandum of Agreement.

A.

SAMAR STATE UNIVERSITY shall:

         

1.

Pre-select and recommend qualified students who will undergo On-the-Job

 

Training to the

under the

 
       

(Name of Company/Agency/Corporation)

     

2.

student Traineeship Program or OJT. Designate an OJT Program Coordinator who will coordinate with the company/corporation/agency/establishment regarding the

3.

activities/requirements under the OJT programs. Submit to the company/corporation/agency/establishment whatever

4.

documents are required. Together with the students and parents concerned, renounce and waive any

 

claim against the

for any injury

 
     

(Name of Company/Agency/Corporation)

     
 

that the student-trainees may sustain or any loss that may suffer, personal or pecuniary in the performance of their duties and functions while On-the- Job Training. The waiver of the student-trainees and the parents concerned

 

shall be submitted to the

prior to the

5.

(Name of Company/Agency/Corporation)

commencement of the training. Hold the company/corporation/agency/establishment free from any claims

 

or suit arising from the Memorandum of Agreement.

     

B.

shall:

     
 

(Name of Company/Agency/Corporation)

           

1.

Screen, select and deploy to the different facilities and offices of the company/corporation/agency/establishment, students recommended by SAMAR STATE UNIVERSITY to undergo On-the-Job Training under the

 

Student Traineeship Program or

 

(Name of Company/Agency/Corporation)

           

OJT for a minimum of 240 hours and maximum of 1,600 training hours.

2. Assign an OJT coordinator to oversee the On-the-Job Training of students. It is understood that they will be required to perform duties and functions along their areas of specialization.

3. Accomplish the necessary forms required by SAMAR STATE UNIVERSITY in connection with the On-the-Job training of their students.

4. Issue certificates of completion to students who successfully finish their On- the-Job training.

5. Adopt and enforce rules that will govern the conduct of OJT program. The students shall undergo orientation to the company’s existing rules before actual exposure to the On-the-Job Training.

9

9 SSU-ONJOB-FR-09 01-Aug -2017 Rev. 1 C. Samar State University and Company/Corporation/Agency/Establishment

SSU-ONJOB-FR-09

01-Aug -2017

Rev. 1

C.

Samar State University and Company/Corporation/Agency/Establishment further agree that:

1.

It is expressly understood that there will be no employer-employee relationship between the company/corporation/agency/establishment and the student-trainees of Samar State University.

2.

The student-trainees will be personally responsible for any and all liabilities for damage to property or injury to third persons which maybe occasioned by their intentional or negligent acts while in the course of On-the-Job Training.

3.

The student-trainees and the school OJT program coordinator shall abide with the company/corporation/agency/establishment’s rules and regulations and with those imposed and the OJT program; otherwise they shall be excluded from further participation.

4.

Company/corporation/agency/establishment reserves the right to discontinue the On-the-Job Training Program of any student-trainee upon written notice to the SSU.

5.

Samar State University may withdraw any student-trainee from the OJT program upon prior written notice to be sent to the company/agency/corporation/establishment, one (1) week before the scheduled pull out.

D.

EFFECTIVITY

 

This Agreement is valid for three (3) years commencing on

 
             

(Month/Year)

 

and expiring on

This Agreement may be terminated by any

 
     

(Month/Year)

           

party by giving the other party a written notice thirty (30) days prior to the intended

 

date of termination. Any amendment or extension of this Agreement shall be made

 

in writing upon mutual agreement of the parties.

   
 

In WITNESS WHEREOF, the parties here to have signed this presents on

 

this

day of

20

     
                   
 

SAMAR STATE UNIVERSITY and

 

By:

     

By:

 

(Name of Company/Agency/Corporation)

 

MARILYN D. CARDOSO, Ph.D.

     

University President

 

CEO/Manager/Authorized Representative

 

SIGNED IN THE PRESENCE OF:

           

GIL O. AMOYAN, Ph.D.

   

Director, Industrial Linkages Development Services/OJT Coordinator

 

Company/corporation agency witness

 

10

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES } CATBALOGAN CITY

} S.S

REPUBLIC OF THE PHILIPPINES } CATBALOGAN CITY } S.S SSU-ONJOB-FR-09 01-Aug -2017 Rev. 1 BEFORE ME,

SSU-ONJOB-FR-09

01-Aug -2017

Rev. 1

BEFORE ME, a notary public for and in the above-mentioned jurisdiction, personally appeared the following persons bearing their corresponding competent evidence of their identities indicated below.

 

Name

Evidence of Identity

 

Date and Place Issued

 
 

Dr. Marilyn D. Cardoso

             
 

Samar State University

TIN No. 129-117-797

 

Catbalogan City, Samar

 
                     
 

(Name of Authorized Representative / Head of agency)

TIN No

   
                     
 

(Name of Company/Agency/Corporation)

                   
 

The above-mentioned persons are all known to me to be the same persons

 
 

who executed the foregoing instrument and acknowledged the same as their own

 
 

free will and deed and that of the agency/institution represented. The said

 
 

agreement consists of four (4) pages including this page on which this

 
 

acknowledgment is written.

                   
 

day of

20

in

 
 

Witness my hand and seal on this Philippines.

           

Doc.

:

Page

:

Book

:

Series of

: