Reference No.: BatStateU-FO-OJT-02 Effectivity Date: May 18, 2022 Revision No.

: 02

STUDENT TRAINEE’S PERSONAL HISTORY STATEMENT

Student Information
NAME: DE MESA EREN TROY PUJANTE
LAST FIRST MIDDLE
AGE:21 SEX: MALE FEMALE
HEIGHT: 5’8 WEIGHT: 65 KGS COMPLEXION: FAIR
DISABILITY(IF ANY)
BIRTHDATE: BIRTHPLACE:
0 7 1 0 0 1
m m d d y y LEMERY, BATANGAS

CITIZENSHIP: FILIPINO CIVIL STATUS: SINGLE

PRESENT ADDRESS: 223, SANTOL, BALAYAN, BATANGAS TEL. NO. N/A
PROVINCIAL ADDRESS: SANTOL, BALAYAN, BATANGAS TEL. NO. N/A

Family Background (if parents are deceased, give data for the nearest relative and indicate relationship to
applicant)

FATHER’S NAME: ARCADIO L. DE MESA OCCUPATION: TRICYCLE DRIVER

MOTHER’S NAME: EUGENIA P. DE MESA OCCUPATION: TEACHER
ADDRESS OF PARENTS: 223, SANTOL, BALAYAN,
TEL. NO.: N/A
BATANGAS
GUARDIAN’S NAME: EUGENIA P. DE MESA TEL. NO.: 09361940632
SCHOOL INFORMATION
PROGRAM: BACHELOR OF TECHNICAL
YEAR LEVEL: FOURTH YEAR
VOCATIONAL TEACHER EDUCATION
MAJOR: COMPUTER PROGRAMMING LENGTH OF PROGRAM: 4 YEARS
DEPARTMENT: COLLEGE OF TEACHER SCHOOL ADDRESS: CALOOCAN,
EDUCATION BALAYAN, BATANGAS
OJT COORDINATOR: TEL. NO.:
OJT HEAD: TEL. NO.:
DEAN: TEL. NO.:
In case of emergency, notify
NAME: EUGENIA P. DE MESA RELATIONSHIP: MOTHER
ADDRESS: 223, SANTOL, BALAYAN, BATANGAS TEL. NO.: 09361940632
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.
I hereby certify that the foregoing answers are true and correct to the best to my knowledge, belief and ability.

Signed at: BATANGAS STATE UNIVERSITY Date: January 5, 2023

____EREN TROY P. DE MESA____

Applicant’s Signature over Printed Name