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UNIVERSITY OF THE EAST

Manila Caloocan

APPLICATION FORM FOR ON-THE-JOB TRAINING

________________ April 24, 2014 Date The Dean COLLEGE OF ENGINEERING Dear Dean __________________________ DOMINADOR S. PAGBILAO I would like to apply for deployment in the On-the-Job Training Program for the _____Semester/Summer, SY 20___ - 20___. The following are the particulars about me.

I. PERSONAL DATA
Name: KENNETH BERLIN NACARIO FALLORINA Student No. 20090147196 Course: BSECE Sex:. M Civil Status: S Religion: ROMAN CATHOLIC Mobile No. 09066616578 Home Address: 1826B MINDANAO EXTENSION, SAMPALOC MANILA Telephone No.: 09066616578 Email Address: FALLORINA.KENNETH@GMAIL.COM Name of Father: RENATO FALLORINA Occupation: OFW Name of Mother: JUDITH FALLORINA Occupation: HOUSE WIFE Company/Company Address: GENTEC HAJI ABDULLA ALIREZA CO. LTD.

II. PREFERENCE FOR DEPLOYMENT


Company: NESIC PHILIPPINES INC. Address: 2ND FLOOR EUROVILLA II BUILDING, RUFINO ST. MAKATI CITY Contact Person: MALOU CULLA Position: HUMAN RESOURCES DEPARTMENT Tel No.: +63 (02) 892-4831

_________________________________ KENNETH BERLIN N. FALLORINA Signature of Student over Printed Name Evaluated and recommended by: _________________________ OJT Coordinator Approved by: ________________________________ DOMINADOR S. PAGBILAO Dean

IMPORTANT: Immediately submit (1) copy of the approved application form to the OJT Coordinator Attachment: 1. Computer Generated Evaluation List; and 2. Department Chair's Certification of Completed OJT Pre-requisites

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