Index No. F-IRJ-6.

6-AIT
TECHNOLOGICAL UNIVERSITY OF THE PHILIPPINES
Ayala Blvd., Ermita, Manila, 1000, Philippines Issue No. 01
Tel No. +632-301-3001 local 204 | Fax No. +632-521-4063 Revision No. 00
Email: irjp@tup.edu.ph | Website: www.tup.edu.ph
Date 11242017

APPLICATION FOR SUPERVISED INDUSTRIAL Page 1/1

VAA-IRJ
TRAINING QAC No. CC-11242017

Date:
The OIC-Director
Industrial Relations and Job Placement
This University

Madame:

May I apply for placement in the Supervised Industrial Training I/ II. The following are my
particulars and preferences for your information and guidance.

I. PERSONAL DATA

Name: Justine Allen E. Curaming ID # TUPM-19-4163

Sex : Male Civil Status: Single Religion: Catholic
Home Address: Blk 23 Lt 91 Gentree Villas Pasong kawayan 1 General Trias Cavite

Telephone no. : N/A Cell phone no.: 09294604617

II. ACADEMIC DATA

Course: Bachelor of Engineering Technology Major : Computer Engineering Technology

Year & Section: BET-CPET-4A Session: Day Eve

III. PREFERENCE FOR PLACEMENT

Company: _____________________________________________________________
Address: _____________________________________________________________
Contact Person: _________________________________________________________
Position: Tel. #: ________________________

JUSTINE ALLEN E. CURAMING

(Signature of student over Printed Name)

Recommending Approval:

PROF. HILDA V. ROBINO

Faculty In-Charge
Approved:

PROF. GHAZALI ILLUMINADA R. SISON

OIC-Director

Transaction ID
Signature
 Index No. F-IRJ-6.6-SIW
TECHNOLOGICAL UNIVERSITY OF THE PHILIPPINES
Ayala Blvd., Ermita, Manila, 1000, Philippines Issue No. 01
Tel No. +632-301-3001 local 204 | Fax No. +632-521-4063 Revision No. 00
Email: irjp@tup.edu.ph | Website: www.tup.edu.ph
Date 11242017
Page 1/1
VAA-IRJ WAIVER QAC No. CC-11242017

I, Christine Hope B. Medalla , 21 years old and residing at Blk 6 Lot 5 Golden Subd. Brgy.
Canlalay Biñan, Laguna and applied for Supervised Industrial Training with a cooperating
firm/company/ agency through the request of the Technological University of the Philippines,
Industrial Relations and Job Placement Division and in consideration therefore, hereby freely
and voluntary assume myself the following duties.

1. That I recognize the authority of my Host Training Establishment (HTE) or agency where I
will be placed and submit myself to all the rules and regulation that are imposed upon
me in connection with my training, and\’

2. That I renounce and waive any claim against the cooperating company/agency and the
Technological University of the Philippines for any injury that I may sustain, or loss that I
may suffer, personal or pecuniary, in the performance of my duties or function while under
training.

3. No Employee-Employer relationship.

Signed at Manila, Philippines, this ______ day of ______________2022.

JUSTINE ALLEN E. CURAMING

Signature of Student

Left-Hand Right-Hand Community Tax Certificate No.__________

Thumb mark Thumb mark Place of Issue ________________________
Date of Issue _______________________

CONFORME:

Address:
Signature of Parent/ Guardian

Community Tax Certificate No.__________

Place of Issue ________________________
Date of Issue _______________________

WITNESS:

PROF. HILDA V. ROBINO PROF. ELIPIDIO VIRREY

Faculty-in-Charge OIC – Dean College of Industrial Technology

Transaction ID
Signature