Republic of the Philippines

CAVITE STATE UNIVERSITY

Imus Campus
Cavite Civic Center Palico IV, City of Imus, Cavite 4103
(7 🕿🖷 (046) 471-66-07 / 436-6584
www.cvsu.edu.ph

OJT PLACEMENT FORM

Name of Student Karlo S. Lazaro

Course (Section) BSOA 2A

Personal Contact #. 09451479285

Name of Company Cavite State University Imus Campus

Complete Address Cavite Civic Center Palico IV, City of Imus, Cavite 4103

Date Started March 11, 2024

Schedule (Day/Time) M, W, & TH – 7:00 AM – 6:00 PM, T – 1:00 AM – 6:00 PM

Date of completion April 25, 2024

Name of Immediate Superior Sir Marlo B. Gloriani

Department/Designation Human Resource Development Office

Signature of Immediate Superior

Guardian’s Name/Relation Cynthia S. Lazaro - Mother

Guardian’s Contact # 09451391910

Guardian’s Complete Address BLK 13 LOT 34 Samaria St. Mary Cris Homes

Subdivision, Bucandala 3, Imus, Cavite

Noted:

_____MARLO B. GLORIANI_________________ KARLO S. LAZARO

________________________________

Name & Signature of Immediate Supervisor Name & Signature of the Student-Intern