REPUBLIC OF THE PHILIPPINES

Bambang, Nueva Vizcaya

AFFIDAVIT OF CONSENT AND WAIVER

I, , Filipino, ______ years of age, and residing at

, do hereby depose and say that:

1. I am a student at the NUEVA VIZCAYA STATE UNIVERSITY (NVSU) under the College of
Engineering (COE) and that as a pre-requisite for the completion of my course Bachelor of
Science in Electrical Engineering; I am required to have 240 hours of actual On-the Job-Training
(OJT) for this Mid-Year, School Year 2021-2022.
2. The NVSU, through the undersigned university officials has permitted me to undergo my On-the
Job-Training in your prestigious institution, the located at
;
3. I promise to render the necessary OJT works entrusted to me to the best of my ability in order
that my OJT shall be brought to a successful conclusion and that the host training institution
shall not be adversely affected.
4. While performing the OJT and the duration thereof, I shall abide by all the rules and policies of
the University and the host training institution relative to the work covered by said OJT and such
orders and instructions issued thereby.
5. I shall be punctual and regular in my attendance and shall abide by the evaluation given to me
by host training institution based on such OJT.
6. I declare unconditionally that there exists no employer-employee relationship between me, its
officers, directors, and personnel, free and harmless from any cause or causes of action claims
or otherwise, arising from or in connection with my OJT, which I have or might have, including
money claims, it is being understood that the OJT is just part of my academic preparation and
thus non-compensable.
7. I further hold RESPONSIBLE free NVSU and its faculty, officials, and staff and/or
representatives from any liability whatsoever during the
period of OJT or immediately thereafter while on my way to and/or from the office of the
institution to perform On-The-Job Training or while performing the same or while premise
thereof.

AFFIANT FURTHER SAYETH NAUGHT.

Name and Signature of Student

CONFORME:

Name and Signature of Parent/Guardian

NOTED:

ENGR. MARY B. PASION, D.Eng’g

EE OJT Coordinator

MARY B. PASION, D. Eng’g-ME JULIUS P. SUMALING CARLO F. VADIL, DPA

Dean, College of Engineering SAS Campus Coordinator Campus Administrator
This space is for notary