Reference No.: BatStateU-FO-OJT-06 Effectivity Date: May 18, 2022 Revision No.

: 01

ON-THE-JOB TRAINEE ACCEPTANCE FORM

Date

This is to certify that Mr. /Ms. CARLO EMMANUEL S. VILLEGAS a year

Name of Student Year Level

BIT – CIVIL TECHNOLOGY student in the College of INDUSTRIAL TECHNOLOGY

Program Name of College

- MALVAR Campus, has been officially ACCEPTED AS OJT TRAINEE in

Name of Campus

which is located at
Name of Company Complete Address of the Company

The details of his/her assignment are as follows:

Branch Department/Section:
Name of Supervisor:
Training Schedule (Hours and Days):
Required Number of Hours:
Effective Date of Start:
Pursuant to Republic Act No. 10173, also known as the Data Privacy Act of 2012, the Batangas State University, the National
Engineering University, recognizes its commitment to protect and respect the privacy of its customers and/or stakeholders and
ensure that all information collected from them are all processed in accordance with the principles of transparency, legitimate
purpose and proportionality mandated under the Data Privacy Act of 2012.
Noted by: Conforme:

__________________________
Company Representative
(Signature over Printed Name)
Date:
Position:
Department: CARLO EMMANUEL S. VILLEGAS NOEL S. VILLEGAS
Name of Student Name of Parent/Guardian
Contact Number:
(Signature over Printed Name) (Signature over Printed Name)
Email Address: Date: Date: