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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ISABELA ) S.S.

AFFIDAVIT OF CONSENT AND WAIVER


I, LENARD J. SANTIAGO, Filipino, single and residing at San Juan, Quirino, Isabela, after being duly
sworn by law, does

1. I am a student of the Isabela State University, Echague, Isabela and that as pre-requisites for the
completion of the course, Bachelor of Science in Civil Engineering, I am require to have on-the-job
training (OJT) or practicum;
2. The Isabela State University, through its College Dean, Joel M. Alcaraz, Ph. D. has requested the
company/agency DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS(DPWH) at San Antonio,
Roxas, Isabela to allow me to undergo my practicum there at said company/agency has acceded to said
request;
3. I promise to render the necessary work to the best of my ability in order that my practicum shall
be brought to a successful conclusion and that the university company/agency shall not be adversely
affected;
4. That while performing the practicum and for the duration thereof, I shall abide by all rules and
policies of the university and company/agency relative to work covered by said practicum and such orders
and instructions issued to or be issued thereby;
5. I shall be punctual in my attendance and shall abide by the evaluation given me by said
company/agency on such practicum;
6. I shall declare unconditionally that there exist no employer-employee relationship between said
company/agency, its officer and personnel, free and harmless from any causes of action, claims or
otherwise, arising from or in connection with my practicum is just a part of my academic preparations and
thus non-compensable;
7. I further hold the Isabela State University and DEPARTMENT OF PUBLIC WORKS AND
HIGHWAYS agency free and harmless from any liability whatsoever during the period of practicum or
immediate thereof while on the way to and/or from the office of the said company/agency to perform my
practicum or while performing the same or while in the premises thereof.

AFFIANT FURTHER SAYETH NAUGTH:


LENARD J. SANTIAGO
CONFORME:
____________________________
Parent/Guardian
SUBSCRIBED AND SWORN to before me this __________ day of _____________________,
20______, affiant exhibiting to me his/her Residence Certificate No. _____________________________
issued at ____________________________ on _____________________________.