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

: 01

ON-THE-JOB TRAINEE ACCEPTANCE FORM

01/25/2024

Date

This is to certify that Mr. /Ms. Melvin A. Pamplona a 4th year

Name of Student Year Level

BS In Information Technology student in the College of Informatics and Computing Sciences

Program Name of College

- Pablo Borbon Main Campus II - Alangilan Campus, has been officially ACCEPTED AS OJT TRAINEE in
Name of Campus

Management Information System (MIS) Office which is located at 2/F Jose Rizal Bldg.,
Name of Company Complete Address of the Company

12 Rizal Ave, Poblacion, Batangas City, 4200 Batangas .

The details of his/her assignment are as follows:

Branch Department/Section:

Name of Supervisor:

Training Schedule (Hours and Days):

Required Number of Hours:

Effective Date of Start:

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:

__________________________ MELVIN A. PAMPLONA
Company Representative Name of Student
(Signature over Printed Name) (Signature over Printed Name) NOEL P. PAMPLONA

Date: Date: Name of Parent/Guardian

Position: (Signature over Printed Name)

Date:
Department:

Contact Number:

Email Address: