UNIVERSIDAD DE DAGUPAN

Arellano St., Dagupan City

522-2405 • www.cdd.edu.ph
SCHOOL OF ENGINEERING

ON THE JOB TRAINING WAIVER

I, ___________________________, residing at __________________________________________ and has

applied for OJT with the COMPANY/AGENCY namely _______________________________ with office address
_______________________________________________ through the request of UNIVERSIDAD DE DAGUPAN
and in consideration therefore, hereby freely and voluntarily assume myself the following terms and
considerations, viz:

1. That I recognize the authority of my cooperating COMPANY/AGENCY where I will be assigned

and submit myself to all the rules and regulations that are imposed upon me in connection with
my training.
2. That I renounce and waive any claim(s) against the cooperating COMPANY/AGENCY and
UNIVERSIDAD DE DAGUPAN for any injury and/or accident, loss that I may suffer, personal or
pecuniary, in the pertinence of my duties or functions while undergoing training, provided that
the cooperating COMPANY/AGENCY ensures my safety and welfare while in their care and
therefore shall not assign me to jobs that may endanger my safety, health and welfare, and
3. Finally, I am aware that I am not entitled to any kind of compensation and /or renumeration
from the COMPANY/AGENCY unless travelling allowance and/or expenses will be given to me
voluntarily by the cooperating COMPANY/AGENCY concerned.

Signed this ________ day of ________, 20 __ in the Municipality/City of ______________

Province of Pangasinan, Philippines.

________________________________________
TRAINEE
CTC No._______________________
Issued at_____________________
Issued on_____________________

PARENT’S/GUARDIAN’S CONSENT
I fully agree with all the terms and conditions provided for in this WAIVER executed by UNIVERSIDAD
DE DAGUPAN, hence I hereby give my full consent for __________________________ to undergo the OJT at
_______________________ for the specified training period of 240 training hours.

_______________________________________
PARENT/GUARDIAN
CTC No._______________________
Issued at_____________________
Issued on_____________________

WITNESSES:

____________________________________ ________________________________
ENGR. JOSE JAY R. DE VERA,ECE,MEP,PhD ENGR. ROMULO ROEL U. PINLAC, ECE
Dean, SCHOOL OF ENGINEERING OJT Coordinator, SCHOOL OF ENGINEERING

Executed and signed before me this ___ day of _________,20 __, this Municipality/City of
______________, Pangasinan.

Doc.No.________
Book No. ______ ___________________________________
Page No. ______ (Notary Public)
Series ________

OJT form 002 s. 2019