Republic of the Philippines

MINDANAO STATE UNIVERSITY

College of Engineering
Fatima, General Santos City
Tel: (083) 302-9623
DEPARTMENT OF ENGINEERING TECHNOLOGY

WAIVER

I, __________________________________, student of Mindanao State University General

Santos City, Engineering Technology Department. Have been granted Permission by the
University to undergo Supervise Industrial Training at the _______________________________
from ______________ to _______________.

Further, I hereby voluntarily agree to undergo the said training in the company/establishment
to acquire actual work experience with the following terms and conditions.

a. That I shall abide by all corporation’s/agency’s rules and regulations and shall comply
with those imposed for the training, otherwise I shall be excluded from further
participation;
b. There is no labor-management relationship between me and the corporation/agency;
c. That I shall exercise care and diligence in any task assigned to me;
d. That the company/agency and Mindanao State University General Santos City shall not
be held responsible for any untoward incident that may happen beyond their control;
e. That I shall be made answerable for any liabilities for damage to property or injury to
the third persons which may be occasioned by my intentional or negligent acts while in
the course of the training and;
f. That the course of training is designed to run for 720 hours.

Signed on this _________ day of __________ at Mindanao State University General Santos City,
Philippines.

__________________________________
Signature over Printed Name of Students

Attested:

_________________________________
Signature over Printed Name of
Parents / Guardian

SUBSCRIBE AND SWORN to before me this ________ day of ____________ 20______ at Mindanao State
University General Santos City, Philippines.

Doc.____________
Page No._________
Bk. No.___________
Series of_________