REQUEST FOR WORK IMMERSION

Dear Sir / Madam,

I am writing to request permission for one of our Senior High School student
_______________________________________ to undergo an 80-hour work immersion in
your company/agency. The purpose of this training is to provide industrial orientation and
practical experience for the student. The training period will commence upon your
acceptance of the bearer and will be conducted in accordance with the terms and conditions
stipulated in the Memorandum of Agreement attached hereto for your review and
confirmation.

In addition, we kindly request your supervisor to evaluate the student's performance, attitude,
and behavior during the immersion period. The Immersion Teacher and Trainer handling the
field of specialization will also visit your establishment periodically to monitor the student's
progress.

We appreciate your cooperation and support in providing this opportunity for our student's
educational and career development. If you have any further queries, please do not hesitate
to contact us.

Thank you for considering this request.

Sincerely,

Work Immersion Teacher

 ENDORSEMENT LETTER

Dear Sir / Madam,

I am writing to introduce ______________________________________________ a Grade

12 Senior High School student enrolled in our school's K to 12 program with a strand in
______________. [He/She] has expressed interest in undergoing an 80-hour work immersion
with your company as a requirement for graduation. We firmly believe that connecting
schools with industries is crucial in keeping our students' education relevant to the needs of
the workforce. Hence, we would like to endorse [his/her] application and request your
favorable consideration.

Please find enclosed an Acceptance Form, which we kindly ask you to accomplish and return
to us upon acceptance of our student in your company. We are confident that [he/she] will be
an asset to your organization and will learn valuable skills and knowledge during the
immersion program.

We appreciate your willingness to provide our students with such opportunities, and we look
forward to establishing a fruitful linkage with your company.

Thank you for your time and consideration.

Very Truly Yours,

Work Immersion Teacher

Noted by:

ADRIAN C. LITAM
School Director, ACLC-Naga
 CERTIFICATION OF ACCEPTANCE FOR WORK IMMERSION

This is to certify that __________________________________has been accepted to

participate in the work immersion program of [Company's Name]
________________________________. [He/She] will be reporting to [Supervisor's
Name] _______________________________ and will be working on [specific job
duties or projects] ___________________________________ from [Start Date]
__________ to [End Date] ___________.

During the work immersion program, [Student's Name

_______________________________ is expected to conduct himself / herself
professionally and abide by the rules and regulations of the company. [He/She] will also
comply with the safety and security procedures of the workplace to prevent accidents
and injuries.

We acknowledge that [Student's Name] ______________________________ is

expected to learn and gain practical experience during his/her immersion program. He
or She will be exposed to various tasks and responsibilities that will help him/her
develop his/her skills and knowledge in _______________________[insert relevant
field of work].

We, [Company's Name] _______________________________, assure that we will

provide a safe and conducive work environment for the student. We will also ensure that
he/she will have proper supervision and guidance to maximize his/her learning
opportunities.

This certification is issued upon the acceptance of [Student's Name]

_______________________________ to the work immersion program of [Company's
Name] ______________________________. We hope that this experience will be a
meaningful and productive one for him/her.

Signature: _________________________
Name: ____________________________
Position: __________________________
Company's Name: ___________________
 WORK IMMERSION EVALUATION FORM

Student’s Name:
Strand:
Partner Institution:
Address:
Contact Number:
Work Immersion Supervisor:
Training Period:
Total Number of Hours Rendered:

Directions: For each behavioral item listed within the competency bands, with 5 being the most
and 1 is the least, please select the evaluation most suited

5 Outstanding Performance exceeds the required standard

4 Very Satisfactory
3 Satisfactory
2 Fair
1 Needs Improvement
NA Not Applicable
Performance fully met job requirements. Was able to perform
what was expected of a person in his/her position.
Performance has met the required standard. Can perform
duties with minimal supervision
Performance partially meets the required standard. Less than
satisfactory could be doing better
Performance does not meet the required standard. Major
Improvements needed.
Performance indicator is not relevant to the job.
 COMPETENCY 5 4 3 2 1
TEAMWORK
1. Consistently works with others to accomplish goals and
tasks.
2. Treats all team members in a respectful courteous
manner.
3. Actively participate in activities or assigned tasks
required
4. Willing to work with the team members to improve
collaboration on a continuous basis.
5. Considers the feedback and views of a team members
when completing an assigned tasks
TOTAL SCORE

COMPETENCY 5 4 3 2 1
COMMUNICATION
1. Actively listens to supervisor and/or co-workers
2. Comprehends written and oral information
3. Consistently delivers accurate information both written
and oral.
4. Reliably provides feedback as required, both internally
and externally.
TOTAL SCORE

COMPETENCY 5 4 3 2 1
ATTENDANCE AND PUNCTUALITY
1. Is punctual on a regular basis.

2. Maintains good attendance.

3. Informs supervisor in a timely manner when
absenteeism and tardiness may occur.
TOTAL SCORE

COMPETENCY 5 4 3 2 1
PRODUCTIVITY/RESILIENCE
1. Consistently produce quality results.
2. Meets deadlines and manages time well.
3. Can do Multitasking.
4. Can work under pressure and delivers the required task
5. Effective and efficient in time management
6. Efficiently informs supervisor of any challenge or
hindrance related to the given task/assignment.
TOTAL SCORE
 COMPETENCY 5 4 3 2 1
INITIATIVE/PROACTIVITY
1. Complete assignments with minimum supervision

2. Completes tasks independently and consistently.

3. Seeks support as needs arises

4. Recognizes and takes immediate action to effectively
address problems and opportunities
5. Engages in continuous learning
6. Contributes new ideas and share skills to improve the
department/organization
TOTAL SCORE

COMPETENCY 5 4 3 2 1
JUDGEMENT/DECISION MAKING
1. Analyzes problems effectively.
2. Has the ability to make creative and effective solutions
to the problems.
TOTAL SCORE

COMPETENCY 5 4 3 2 1
DEPENDABILITY/RELIABILITY
1. Has the ability to follow through and meet deadlines.
2. Has commitment for his/her action
3. Can adjust easily to changes in workplace.
4. Displays high level of performance at all times.
TOTAL SCORE

COMPETENCY 5 4 3 2 1
ATTITUDE
1. Offers assistance willingly.
2. Shows a positive work attitude.
3. Shows sensitivity to and consideration for other’s
feelings.
4. Accepts criticism positively.
5. Shows pride in work.
TOTAL SCORE

COMPETENCY 5 4 3 2 1
PROFESSIONALISM
1. Respects person’s authority.
2. Uses all tools, equipment and facilities responsibly
3. Follows all policies and procedures when issues and
conflict arises.
4. Physical appearance conforms with the workplace and
placement rules.
TOTAL SCORE

SUMMARY OF SCORES

WEIGHTED
CRITERIA
AVERAGE
TEAM WORK
COMMUNICATION
ATTENDANCE & PUNCTUALITY
PRODUCTIVITY/RESILIENCE
INITIATIVE/PROACTIVITY
JUDGEMENT/ DECISION MAKING
DEPENDABILITY/RELIABILITY
ATTITUDE
PROFESSIONALISM
Over-All Weighted Average
Equivalent Grade

REMARKS: (Comments/Suggestions)

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Student’s Signature:_____________________________________ Date:__________________

Work Immersion Supervisor’s Signature over Printed Name: ____________________________