Reference No.: BatStateU-FO-OJT-06 Effectivity Date: May 18, 2022 Revision No.

: 01

ON-THE-JOB TRAINEE ACCEPTANCE FORM

January 24, 2023
Date

This is to certify that Mr. /Ms. Mark Anthony I. Matic a Fourth year
Name of Student Year Level

Computer Technology student in the College of Industrial technology

Program Name of College

accepted as STUDENT-TRAINEE
- Batangas State University - Lipa Campus Campus, has been officially ACCEPTED AS OJT TRAINEE inat
Name of Campus

Department of Information and Communication Technologywhich is located at B. Morada Avenue,

Name of Company Complete Address of the Company

Lipa City, 4217 Batangas .

The details of his/her assignment are as follows:

Branch Department/Section:
Name of Supervisor: Cheryl C. Ortega
Training Schedule (Hours and Days):
Required Number of Hours: 540 Hours
Effective Date of Start: January 30, 2023
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.
Noted by: Conforme:

Cheryl C. Ortega
__________________________
Company Representative
(Signature over Printed Name)
Date:
Position: Regional Director
Department: ______________________
Mark Anthony I. Matic ______________________
Marites I. Matic
Name of Student Name of Parent/Guardian
Contact Number:
(Signature over Printed Name) (Signature over Printed Name)
Email Address: Date: Date: