San Mateo Municipal College

(formerly Pamantasan ng Bayan ng San Mateo)

General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

PERFORMANCE EVALUATION FORM

(Practicum / On-the-Job Training)

Name of Student: RENIE T. BUSTAMANTE Program/Year: BSOA/2023

Date Covered: From September 27, 2023 to November 24, 2023
Dear Rater:
This form was designed to monitor each practicum student's performance not just for
grading purposes but also to offer a basis for identifying his or her strengths and weaknesses:
Kindly rate the trainee in each of the traits indicated below by encircling the appropriate
number that corresponds to your OBJECTIVE EVALUATION of his/her performance in your
department using the scale provided.
5 – Outstanding (O)
4 – Very Satisfactory (VS)
3 – Satisfactory (S)
2 – Needs Improvement (NI)
1 – Unacceptable (U)

CRITERIA O VS S NI U
A.QUALITY OF WORK

1. Accuracy of completed work according to the 5 4 3 2 1

operational standards

2. Thoroughness & attention to detail in performing 5 4 3 2 1

the assigned tasks.

3. Neatness & presentation of work. 5 4 3 2 1

B. PRODUCTIVITY
1. Effective use of time 5 4 3 2 1
2. Task Accomplished 5 4 3 2 1
3. Prompt completion of work assignments 5 4 3 2 1

4. Useful or effective application of knowledge & 5 4 3 2 1

skills
C. WORK HABITS, TALENTS & SKILLS
1. Appropriate Attire 5 4 3 2 1

2. Adherence to policies & procedures 5 4 3 2 1

3. Attendance & punctuality 5 4 3 2 1

4. Ability to communicate effectively to client, 5 4 3 2 1

colleagues and supervisor.

5. Ability to think independently. 5 4 3 2 1

6. Ability to remain calm & in control when
presented with stressful situations. 5 4 3 2 1
7. Demonstrates an interest & willingness to learn 5 4 3 2 1
the task required to maintain operational
standards.

D. INTERPERSONAL WORK RELATIONSHIP

1. Demonstrates positive relationship with the 5 4 3 2 1
establishments’ workers.
2. Relates effectively with visitors in a friendly & 5 4 3 2 1
 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

courteous manner.
3. Accepts suggestions, directions & constructive 5 4 3 2 1
criticism from employees & supervisors.
4. Cooperative team player. 5 4 3 2 1

Comments, general impressions & observations regarding the capability, behavior & personality
of the trainee.
____________________________________________________________________________
____________________________________________________________________________
_________________________________________________________________________
Evaluated by:
_______________________
Signature over Printed Name

______________________
Position/ Designation
NOTE: Please complete this evaluation form and sign it before placing it in a sealed envelope.
 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

On-the-Job Training SLIP

School/Company Information:
School Company Name:__________________________________________
School/Company Address: ________________________________________
Contact Person: ______________________________________
Position: ____________________ Contact No.: _______________________
School / Company Email Address: __________________________

Student Trainee’s Information:

Student Trainee’s Name: Mr/Ms __________________________________
Program: ______________________________________________________
Address: ______________________________________________________
Birthday: ___________________ Age: _________ Gender: ______________
Contact No.: _______________ Email Address: _______________________

Parent/Guardian Information:
Parent/Guardian Name: Mr/Ms ____________________________________
Address: ______________________________________________________
Contact No.: ______________________ e-mail: ______________________
 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

— NOTES —

*Submit sketch of School/Company location and Job Description on a

SEPARATE sheet of paper.

September 25, 2023

Parent/Guardian’s Certificate of Waiver/Permission

 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

This is to certify that I am allowing my son/daughter, Renie T. Bustamante to undergo an on-

the-job training for a total period of THREE HUNDRED (300) HOURS at Office of the
Congressman 3rd District in partial fulfillment of the requirements for the Degree of Bachelor
of Science in Office Administration.

It is understood that he/she will abide by the rules and regulations that may be imposed by the
OJT Supervisor/Head in charge of his/her welfare and safety. I fully agree to waive any liability
on the part of San Mateo Municipal College and the Office of the Congressman 3rd District
(OJT Employer) in case of any untoward incident that may happen to my son/daughter during
the duration of this practicum.
___________________________________________
Arnold B. Luminog / September 25, 2023
RENIE T. BUSTAMANTE / September 25, 2023

Home address and Telephone/Mobile No. of Parent/Guardian:

Blk 2b Lot 10 Sampaguita Street Modesta Village Barangay Sto. Niño, San Mateo, Rizal.
Arnold B. Luminog – 09

E-mail Address and Telephone/Mobile no. of Student:

boknoyrene@gmail.com Renie T. Bustamante - 09356196642

Noted by:

_____________________________
Prof. MARILOU A. LASERNA MBA

___________________________
Dr. ARLENE F. MUSONES MBA

_______________________
Prof. NESTOR M. TADENA

AFFILIATION AGREEMENT FOR INTERNSHIP EXPERIENCE

KNOW ALL MEN BY THESE PRESENTS:

This AFFILIATION AGREMENT made and entered into by and between:

 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

SAN MATEO MUNICIPAL COLLEGE, a non-stock, non-profit educational institution,

duly recognized by the Commission on Higher Education, represented by PROF.
NESTOR M. TADENA, VP for Academic Affairs and DR. MA. VERONICA C. IRINGAN,
Dean, Institute of Arts and Sciences, and Ms. ALONDRA ARA MENA, Program
Coordinator, with office address at General Luna St, Guitnang Bayan I, San Mateo.

AND

, with principal address at by Mr. , Admin Chief of Staff.

WITNESSETH:

This Affiliation Agreement provides both parties a venue to arrange (subject to certain
terms and conditions set in a separate contract/agreement) mutual partnership
provisions for the engagement of students under the on-the-job training/internship
curriculum and for alumni employment programs of SMMC with <partner school>.

Terms and Conditions:

SMMC shall provide 3rd District Office of the Congressman student-trainees who will
undergo the training program solely for the purpose of allowing the student-trainees to
complete the College’s requirement for graduation.
As our Training Partner, we would like to inform you that they are subject to the
following terms and condition:

1. The period of training shall not exceed the prescribed number of hours indicated
in the recommendation letter presented which shall run for eight (8) hours a day.
In case that the company needed the services of the students beyond the
prescribed time, the excess hours shall be credited to the students.

2. Student trainee shall observe the existing rules and regulations of the company.

3. Your company will not be held liable for any untoward incident that may happen
during the training period.

4. This agreement is made upon request as recommended, therefore, your

company has no obligation, whatsoever, to consider student trainees as
employee during and after the training period.

While it is understood that this agreement shall not create an employer-employee

relationship between 3rd District Office of the Congressman and the student trainees,
3rd District Office of the Congressman shall provide law-mandated safety and security
orientation and provisions to ensure the well-being of the student-trainees while in the
premises and/or accomplishing office tasks.

The partnership shall be implemented by the parties in accordance with the guidelines
and policies of the parties, and as set forth or agreed by the parties in separate
agreements.

Duration:

This agreement affiliation shall take effect upon signing by the authorized officials from
SMMC and 3rd District Office of the Congressman and will remain in effect until
modified or terminated by any of the partners by mutual consent. This agreement
affiliation shall be valid for one (1) year, from September 25, 2023 to September 25,
2024.
 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

IN WITNESS WHEREOF, the parties have hereunto signed this Agreement Affiliation
this September 25, 2023, at Kambal Road Guitnang Bayan, San Mateo, Rizal,
Philippines.

For San Mateo Municipal College FOR 3rd District Office of the
Congressman

Prof. MARILOU A. LASERNA MBA

BSOA, Program Coordinator

Dr. ARLENE F. MUSONES MBA Mr.

DEAN, Institute of Arts and Sciences Admin Officer-In-Charge,
3 rd District Office of the Congressman

Prof. NESTOR M. TADENA

VP for Academic Affairs

Mr. ROI ANDREI B. DESCALLAR Ms. JO-ANNE Y. JUTA

Witness Witness
 San Mateo Municipal College
(formerly Pamantasan ng Bayan ng San Mateo)
General Luna St., Guitnangbayan I, San Mateo, Rizal
Tel. No. (02) 8997-9070
www.smmc.edu.ph

September 25, 2023

<name>
Admin Office-In-Charge
3rd District Office of the Congressman
Kambal Road Guitnang Bayan, San Mateo, Rizal

Dear ______;

Greetings from San Mateo Municipal College!

The Institute of Arts and Sciences facilitates student success by providing them the
opportunity in becoming proficient in the fundamental areas of psychology. This program
encourages learners to engage in internships and on-the-job training to gain real-world
experience with a wide variety of activities that offer exposure to current application of
appropriate tools and techniques at work. Part of this engagement is at least and not below 300
hours of training as requirement to be completed by the student.

Being one of our reputable partners in this endeavor, we consider your organization to
be in the best position to provide optimal and relevant training support, knowledge and essential
skills that will allow them to maximize trainings ad opportunities for prospective employment.

In this regard, may we request your reputable organization to accept RENIE T.

BUSTAMANTE a fourth-year BS Office Administration student, who is also enrolled this 1 ST
Semester, AY. 2023-2024, as an intern in this area.

Rest assured that as partners, we will ensure collaboration to strategically provide the
best experience to our intern. Proper monitoring of development and performance of our
student-intern will be employed utilizing institutional assessment protocols.

With utmost gratitude as we anticipate having a successful partnership with you.

Very truly yours,

_________________
Prof. MARILOU A. LASERNA MBA

Noted:
___________
Dr. ARLENE F. MUSONES MBA