Document Code No.

FM-SSCTDC-PLM-001
SURIGAO STATE COLLEGE Revision No. 00
OF TECHNOLOGY Effective Date 20 September 2018
Page No. 1 of 1

STUDENT TRAINEE INFORMATION SHEET

1. NAME : LONGOS ARNIE BUO MALE

(Surname) (First Name) (Middle Name) (Sex)
2. Home Address : PUROK 4, BRGY. SAYAK, DEL CARMEN, SURIGAO DEL NORTE
3. Date of Birth : MAY 30, 1997 Place of Birth: SAYAK, DEL CARMEN, SURIGAO DEL NORTE
4. Civil Status : SINGLE__ Religion: ROMAN CATHOLIC/CHRISTIAN
5. Height : 5’6” Weight: 57 Kg. Contact #: 09505341730
6. Name of Parent or Guardian: ARLINDA B. LONGOS
7. Address : PUROK 4, BRGY. SAYAK, DEL CARMEN, SURIGAO DEL NORTE
8. Person to be contact in case of emergency: EDLYN B. LONGOS
Address : PUROK 4, BRGY. SAYAK, DEL CARMEN, SURIGAO DEL NORTE
Contact No. : 0956134623
9. EDUCATIONAL BACKGROUND
Elementary : SAYAK CENTRAL ELEMENTARY SCHOOL Date Graduated: 2012
Secondary : OGUING NAVARRO MEMORIAL NATIONAL HIGH SCHOOL Date Graduated: 2018
College : SURIGAO DEL NORTE STATE UNIVERSITY
Collegiate Course: BACHELOR OF SCIENCE IN INDUSTRIAL TECHNOLOGY – ELECTRICAL
TECH.
Other Skills : _________________________________________________________
_________________________________________________________

10. PREVIOUS TRAINING OR EMPLOYMENT RECORD

COMPANY/TRAINING CENTERS POSITION ADDRESS

11. CHARACTER REFERENCE (Not related to you)

Name Position Address

REYMOND P. PIEDAD BSIT PROGRAM CHAIR SNSU – DEL CARMEN
ELWIN S. ARGANA CHIEF ADMINISTRATIVE OFFICER SNSU – DEL CARMEN
CHRYSLER VAN D. CONDE PLACEMENT COORDINATOR SNSU – DEL CARMEN

Res. Cert. No. 03537423

Issued at: Sayak, Del Carmen, Surigao del Norte
Issued on: September 23, 2022

2” x 2” ID
Photo

I HEREBY CERTIFY that the above

information is true and correct to the best of my
Knowledge and belief

ARNIE B. LONGOS
Print Name and Signature