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F-OJT-02

2X2
PICTURE

PERSONAL DATA SHEET

Name: Cacao, Jerico Enriquez Student No.: 1500332____

Address: 0932 Lumbangan St., Aya, Talisay, Batangas

Course: Bachelor of Science In Civil Engineering ____________________________________

Major: Civil Engineering _________________ OJT hours: _240 hrs____________________

Contact no. (landline): _____________________(cellular): 09456955865________________

Person to notify in case of emergency: Antonio M. Cacao ____________________________

Relationship: _Father____________________ Contact no.: 09301306924 _______________

COMPANY INFORMATION

Name of Company: _Provincial Engineer's Office___________Contact No.: 723-6115_______

Address of Company: Kumintang Ilaya, Batangas City ________________________________

Contact Person: Marietes Turioco_______________Position: Supervising Admin. Officer_____

CONFORME: By signing below, I hereby voluntarily waive any and all rights I may have to privacy and/or confidentiality
pertaining to the above-mentioned purposes insofar as the information is released solely to the authorized persons in
accordance thereto.

_________Jerico E. Cacao_________
Signature over Printed Name

____________________
Date Signed

Revision No.: 2 Campuses: Hilltop | MH del Pilar | Pallocan East | Pallocan West | Lipa
Issue Date: August 24, 2018 Telephone Numbers: +63 43 723 1446 | 980 0041
Revision Date: August 20, 2018 Website: www.ub.edu.ph

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