Application for OJT Assignment

Date: ____________________

Name: ____________________ Phone No.____________________

Major: ____________________

Establishment Applied for OJT______________________________

Proprietor/Manager___________________________

Address______________________________________

Requirement Narrative Report of Jobs Done, Daily Time Record (DTR)

Recommending Approval:

____________
Chair, Major Area

Approved:

JESSILTON T. VEJANO, MAEM

Dean, College of Industrial Technology
 Internship Agreement
_______________

Date

The (Cooperating Agency) agrees to permit

__________________________________ (Student’s Name) to work in this establishment under

inplant training in various phases of his field of study. In addition, it is agreed that:

1. The duration of the in-plant training program is designed for __________months with a minimum
of ______hours as academic requirement;

2. The training period begins on _______________to___________________________________;

3. The student while in the process of training will have the status of student trainee, neither
displacing a regular worker presently employed nor substituting a worker needed by the
Cooperating Agency;

4. The student agrees to perform diligently the work assigned to him by the Cooperating Agency;
he/she also agrees to pursue faithfully the prescribed courses of study and to take advantage of
every opportunity to improve his/her efficiency, knowledge and personal traits so that he/she may
enter his choice occupation as a desirable employee at the termination of the training period;

5. The NORSU OJT coordinator shall make supervisory and instructional visits to the cooperating
Agency during the training period to observe the student’s progress and to discuss training
problems that may occur;

6. The NORSU Placement Officer, upon the recommendation of the OJT Coordinator shall have the
authority to transfer or withdraw the student-trainee at any specific situation that warrants such
change of assignment;

7. The cooperating Agency shall evaluate or rate the student’s performance and discuss with him at
any time pertinent issues regarding the training.

8. All complaints regarding the conductor the performance of the student-trainee shall be made to the
university;

9. The student shall abide with all the establishment’s rules and regulations and shall comply with
those imposed for the program. Otherwise, the student shall be excluded from further participation;

10. There is no labor-management relationship between the student-trainee and the Cooperating
Agency;

11. The student renounces and waives his/her claim against the Cooperating Agency for any injury
that he/she may sustain, or loss that he/she may suffer, personal or pecuniary in the performance
of his/her duties or functions while under training. Provided further, that the Cooperating Agency
exerts utmost effort for the safety and welfare of the student while on duty and;

12. The Student-trainee shall be made answerable for any/all liabilities for damage to property or
injury to another person caused by his/her intentional or negligent acts while in the course of his/her
training; and that the Cooperating Agency shall exercise diligence in the supervision of and
instruction of the student-trainee with the diligence of a good father of the family during and in the
course of the latter’s training.
SAO FORM I Revised
2013
13. Monthly/weekly reports/progress reports are to be determined by the OJT Coordinator.

14. The school will be informed of any changes especially in the site/location of designated duty.

15. This internship agreement is subject to the student-trainee’s official enrollment to his/her
summer/semestral class for apprenticeships covering the period of the said school year.

_____________________________________ _____________________________________
Name and Signature of Student Name and Signature of Parent/Guardian

_____________________________________ _____________________________________
Name and Signature of Adviser Name and Signature of College Coordinator

JESSILTON T. VEJANO, MAEM

Dean, College of Industrial Technology (CIT)

ENGR. JOSELITO D. PAMOR

Campus OJT Coordinator

JOEL T. UBAT, Ph. D.

Campus Director, Student Affairs Office
NORSU Guihulngan City Campus

RICHARD B. OSUMO, MS Crim.

Campus Administrator
NORSU Guihulngan City Campus

APPROVED BY:

_______________________ __________________

Name and Signature of Company Manager/Supervisor

SUBSCRIBED AND SWORN to before me this ______ day of ___________ in Guihulngan City,
Neg. Or. Phil., affiant exhibited to me his/her CTC No. ___________
CTC N0. Php
Date of Issue
Place of Issue

SAO FORM I Revised

2013
 (Note: Submit a photocopy of this document to your OJT COORDINATOR or ADVISER
after completion of all signatures.)

13. Monthly/weekly reports/progress reports are to be determined by the OJT Coordinator.

14. The school will be informed of any changes especially in the site/location of designated duty.

15. This internship agreement is subject to the student-trainee’s official enrollment to his/her
summer/semestral class for apprenticeships covering the period of the said school year.

_____________________________________ _____________________________________
Name and Signature of Student Name and Signature of Parent/Guardian

_____________________________________ _____________________________________
Name and Signature of Adviser Name and Signature of College Coordinator

JESSILTON T. VEJANO, MAEM

Dean, College of Industrial Technology (CIT)

ENGR. JOSELITO D. PAMOR

Campus OJT Coordinator

JOEL T. UBAT, Ph. D.

Campus Director, Student Affairs Office
NORSU Guihulngan City Campus

RICHARD B. OSUMO, MS Crim.

Campus Administrator
NORSU Guihulngan City Campus

APPROVED BY:
_____________________________________ _____________________________________
Name and Signature of Head of Office Name and Signature of City/Municipality Mayor

SUBSCRIBED AND SWORN to before me this ______ day of ___________ in Guihulngan City,
Neg. Or. Phil., affiant exhibited to me his/her CTC No. ___________
CTC N0. Php

SAO FORM I Revised

2013
 Date of Issue
Place of Issue

(Note: Submit a photocopy of this document to your OJT COORDINATOR or ADVISER

after completion of all signatures.)

PERFORMANCE RATING SHEET

Internship/ On-the-Job Training
Name of Student-Trainee: ___________________________ Course:____________________________
Name of Company: ___________________________________________________________________
Assignments: ________________________________________________________________________
PERFORMANCE RATING SHEET
1 2 3 4 5 SCORE
Poor Unsatisfactory Satisfactory Very Outstanding
Satisfactory
QUALITY OF WORK Inferior, Meets Superior Exceptional
extremely poor expectations
in quality

Passive
Average in
ATTITUDE Optimistic, Optimistic,
diligence and
motivated and motivated,
interest
focused focused and
exceptionally
creative
Poor, lacks
common sense Sensible and Exceptionally
Sensible and mature
decides
JUDGEMENT usually makes
appropriately on
right decisions
the task at
with little to
hand with few
no supervision
errors

Generally
Unwilling to accept willing to Always willing
and carry Quick to
accept and carry to accept and
out instruction volunteer/
out carry out
COOPERATION Eager to accept
instruction instruction and carry out
instruction

Displays Reliable with Displays an

inconsistent good work ethic excellent work
With strong
work ethic ethic
work ethic,
needs less
Able to adjust supervision
DEPENDABILITY and adapt Readily adjusts
Not able to adjust
to appropriately to Adjusts to to changing
stressful or stressful changing priorities and is
changing circumstances circumstances able to generate
circumstances with less effective
guidance solutions
RESOURCEFULNESS

Extra vigilantto
potential
Cautious workplace
Careless/ (Observes hazard and
necessary Sees visible employs
negligent
precautions) hazards and necessary
suggests need for precautions
improvement

SAO FORM I Revised

2013
SAFETY

Overall Performance = Score Obtainedx 50+50

35
Overall Performance Failed 75-79 80-84 85-89 90-94 95-100

NORSU Grade Beyond 3.0 3.0-2.7 2.5-2.2 2.0-1.7 1.5-1.2 1.00

Equivalent

Description Failed Passing Good Very Good Superior Excellent

Attendance ____ Regular _____Irregular

Punctuality ____ Regular _____Irregular

TOTAL:_________________
Name and Signature of the Evaluator: __________________________ Position: ________________________
NOTE: This Performance Rating Sheet shall be the basis for the Final Rating Scale

FINAL RATING SCALE

Internship/On-the-Job-Training

SAO FORM I Revised

2013
Name of Company / Office: _____________________________________________
Name of Intern: _____________________________________________
Major Field: _____________________________________________
Date Begun: _____________________________________________ Date
Terminated: _____________________________________________

PERFORMANCE SCALE
CRITERIA GRADE POINT RATING
1.Daily Attendance 20%
2. Attitude Towards Work 15%
3.Workmanship / Quality of Completed Job 15%
4.Speed / Accuracy of Completed Job 20%
5.Correct Use and Maintenance of Tools and Machine (Method Safety) 20%
6.Relationship with Co-Workers and Supervisors 10%
TOTAL 100%

______________________________
Signature of Foreman / Supervisor
SEAL OF OFFICE

____________________________
Signature of Manager / Officer

Summer__________
ON-THE-JOB-TRAINING _______ Units ____Hrs.

First Semester____________ Second Semester_____________

ON-THE-JOB-TRAINING ON-THE-JOB-TRAINING
_____Units ____Hrs. _____Units ____Hrs.

`
NOTE: Ceiling or Highest Grade given to student-trainee is 90%. However, for exceptional cases
when the apprentice is found to be Superior in Performance he / she can be given a maximum grade
of 95%.

STUDENT TRAINEE’S CLEARANCE

________________
Date
________________ _________________

SAO FORM I Revised

2013
_________________

Sir/Madame:

May I have the honor to request for a clearance on property accountabilities, money and other
requirements from your company/firm.

Very truly yours,

_____________________
Student Trainee
(Printed Name & Signature)

ACCOUNTABILITIES SIGNATURE

Tools/ Equipment _______________

Job Orders/ Reports _______________ Cafeteria/
Canteen _______________

Cleared as to reports, money and property accountability.

_____________________ ___________________
Foreman/Supervisor Manager/ Proprietor
(Printed Name & Signature) (Printed Name & Signature)

SAO FORM I Revised

2013