Carcar Central National High School

P. Nellas St., Carcar City, Cebu

Tel. No. (032) 487 – 8205

Senior High School Department

LETTER OF ENDORSEMENT

( DATE )

( NAME OF THE OWNER )

( POSITION )
( NAME OF THE COMPANY )
( ADDRESS )

Dear Mam:

This refers to the requirement of the Electronic Products Assembly and Servicing
curriculum of Carcar Central National High School for students to undergo a
Work Immersion Program for a minimum of 160 hours in any company with
Electronics Technology base.

In view of this, we would like to request that ( NAME OF STUDENTS ) to have her
Work Immersion Training in your company. In this manner, she/he will have an
opportunity to apply his/her theoretical knowledge in actual practice.

We believe that your company can provide the relevant exposure to future
Technicians, thus ensuring the continuous supply of highly qualified personnel.

We would highly appreciate whatever assistance you could extend to us that

would, in the long run, be both beneficial to the student and your company.

Thank you and we look forward to your kind consideration and support.

Very truly yours,

EULOGIO L. LICAROS JR.

WORK IMMERSION TEACHER

Noted By:

MICHELLE B. HECHANOVA
Principal - 1
Carcar Central National High School
 Carcar Central National High School
P. Nellas St., Carcar City, Cebu
Tel. No. (032) 487 – 8205

Senior High School Department

Student’s Information Sheet

PERSONAL INFORMATION:
Name: ( FIRST NAME, MI., LAST NAME )
Course: Electronic Products Assembly and Servicing Year: Grade 12
Nationality: Filipino
Address: ( COMPLETE ADDRESS )
Cell. No.: ( NUMBER )
Date of Birth: ( M/D/Y ) Place of Birth: Carcar City, Cebu
Age: Sex: Height: cm Weight: kg.

FAMILY BACKGROUND:
Father’s Name: Occupation:
Mother’s Name: Occupation: Housewife
Address of Parents:
Guardian: Occupation:
Address:
Contact Number of Guardian:

SCHOOL DATA:
Name of School: Carcar Central National High School
Training Coordinator: Eulogio L. Licaros Jr. Mobile No.: 0933-4139-652
School Address: P. Nellas St., Pob. III, Carcar City, Cebu
Head of School: Rolando B. Pansit

IN CASE OF EMERGENCY:
Name: Relationship: Mother
Address: Cel. No:

I HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE ARE TRUE

AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

______________________________
Signature over Printed Name Right Thumb Mark

1x1 ID Picture

Date:
 Carcar Central National High School
P. Nellas St., Carcar City, Cebu
Tel. No. (032) 487 – 8205

Senior High School Department

APPLICATION LETTER

( DATE )

( NAME OF THE OWNER )

( POSITION )
( NAME OF THE COMPANY )
( ADDRESS )

Dear Sir:

As a grade 12 Electronic Products Assembly and Servicing (EPAS) student of

Carcar Central National High School, I am required to undergo a Work
Immersion Program (WIP) for a minimum of 160 hours (20 days). This is in
partial fulfillment of the requirements of the course.

I am applying in your company as a trainee because I believe that the experience

I will obtain will surely improve my skills and acquire additional knowledge in the
field of Electronic Products Assembly and Servicing (EPAS).

We are hoping for your favorable response to this matter.

Thank you very much and God bless.

Very truly yours;

( STUDENT NAME WITH SIGNATURE )

( ADDRESS )
Contact Number: ( NUMBER )

Noted by:

EULOGIO L. LICAROS JR.

Work Immersion Teacher,
Electronic Products Assembly and Servicing NC II
Carcar Central National High School
P. Nellas St., Carcar City, Cebu
 Carcar Central National High School
P. Nellas St., Carcar City, Cebu
Tel. No. (032) 487 – 8205

Senior High School Department

WAIVER

I, ( NAME OF STUDENT ) of legal age, single, and residing at

( ADDRESS ), Cebu through the request of CARCAR CENTRAL NATIONAL
HIGH SCHOOL and ( NAME OF COMPANY ) in consideration thereof, hereby
freely and voluntarily assume and impose upon myself the following duties:

That I recognize the authority of the ( NAME OF COMPANY ) under whom I am

places and submit myself to rules and regulations that maybe imposed in
connection with my training;

That I assume full responsibility to all damages incurred by me arising out of and
in course of my training during off hours;

Furthermore, I renounce and waive any all claims against the CARCAR
CENTRAL NATIONAL HIGH SCHOOL and ( NAME OF COMPANY ) for any
injury that may sustain or any loss that I may suffer, personal or pecuniary, in the
performance of my duties or function.

Signed at Carcar City, Cebu this ( DATE ).

( SIGNATURE OF STUDENT )
Signature

Witness:

EULOGIO L. LICAROS JR.

 Carcar Central National High School
P. Nellas St., Carcar City, Cebu
Tel. No. (032) 487 – 8205

Senior High School Department

PARENTAL CONSENT AND WAIVER FORM

I, (Name Parent or Guardian)_ grant permission for my son/daughter,

___________(Student Name)__________ ,to participate in the Work
Immersion Program which is one of the course requirements for graduation.
The undersigned has understood that my son/daughter has to undergo work
immersion in a business organization or establishment with work
requirement related to the specialization.

I, as parent and / or legal guardian, remain legally responsible for any

personal actions taken by the above-mentioned Senior High School students.
I agree on behalf of my child named herein , or our heirs, successors and
assigns, to hold harmless and defend CARCAR CENTRAL NATIONAL
HIGH SCHOOL ( CCNHS ) , its administrator, school head , faculty, or
actions , claims, demands, damages, costs, expenses and all consequential
damage arising from or in connection with my child participating the
immersion program or in connection with any illness or injury or cost of
medical treatment in connection therewith.

In signing the Parental Consent and Waver, I am not relying on any oral
or written representation or statement made by CCNHS and, its
administrator, school head, faculty , or representatives associated with the
implementation of the work immersion program , other than those set out
in this Consent and Waiver.

I am of legal age and have read and understand the terms of this consent
and waiver, and recognize that it is binding upon me, my heirs, executors
and administrator.

........................................................................... ………………….
Parent/Guardian Signature Over Printed Name Date