Maryknoll College of Panabo, Inc.

(Formerly Maryknoll High School of Panabo, Inc.)

National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

PARENTS/GUARDIANS WAIVER
NAME OF PARENT: ______________________________________

ADDRESS: ______________________________________

NAME OF STUDENT: ______________________________________

TRAINING/COURSE: ______________________________________

TRAINING LOCATION: ______________________________________

TRAINING DURATION: ______________________________________

I, the aforenamed parent/guardian of the aforesaid student, of legal age, after having
been duly sworn to accordance with the law depose and state that:

1 I am legitimate parent or legal guardian of the aforenamed student, the next-of-kin

with legal custody and who is supporting said student through his/her studies and
basic needs;
2 As a requirement for the aforesaid course, I hereby approve and voluntary agree to
the participation of the said student to the work immersion to be conducted at the
aforestated location and duration;
3 I have fully considered the educational and training benefits of participation in such
work immersion with the understanding that every precaution shall be taken by the
MCPI management, employees or their agents to ensure the safety of their students;
4 I am aware that the MCPI has secured the necessary accident insurance for the
students in this training;
5 I however also understand that MCPI, its management, employees or agents shall not
be held liable for any untoward incident that may happen beyond their control or
arising from force majeure and undertake to inhibit from filing any criminal, civil or
administrative action against MCPI, its management, employees or agents, forever
holding them harmless and free from liability should such untoward incidents beyond
their control ever occur.

IN WITNESS WHEREOF, I hereby set my hands this _______________at Panabo City,

Davao del Norte, Philippines.

__________________________________
SIGNATURE ABOVE PRINTED NAME OF PARENT/LEGAL GUARDIAN
AFFIANT
ID ____________ ID# __________________

Republic of the Philippines }

Province of Davao del Norte }s.s.
City of Panabo }

SUBSCRIBED AND SWORN TO before me this _____________________ at Panabo City, Davao del Norte,
Philippines. Affiant exhibited to me the IDs stated as competent proof of identity.

Doc. No.: ___;

Page No.: ___;
Book No.: ___;

Series of 2019
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

STUDENT WAIVER
NAME OF STUDENT: ______________________________________

HOME ADDRESS: ______________________________________

SEX/BIRTHDATE: ______________________________________

TRAINING/COURSE: ______________________________________

TRAINING LOCATION: ______________________________________

TRAINING DURATION: ______________________________________

I, the aforenamed student, child/minor, after having been duly sworn to accordance
with the law depose and state that:

1 I am enrolled in the aforesaid training course;

2 I intend to participate in the work immersion to be conducted at the aforestated
location and duration;
3 I promise and undertake to exercise maximum caution and safety, to take diligent care
of my person and belongings and shall not participate in any risk-taking behavior nor
endanger myself, equipment or facilities under my care;
4 I undertake to cooperate and participate in all activities and measures undertaken by
the MCPI management, employees or their agents to ensure my safety and that of the
other students;
5 I understand that MCPI, its management, employees or agents shall not be held liable
for any untoward incident that may happen beyond their control, or, due to force
majeure and undertake to inhibit from filing any criminal, civil or administrative action
against MCPI, its management, employees or agents, forever holding them harmless
and free from liability should such untoward incidents beyond their control ever occur.

IN WITNESS WHEREOF, I hereby set my hands this _______________at Panabo City,

Davao del Norte, Philippines.

__________________________________
SIGNATURE ABOVE PRINTED NAME OF STUDENT
AFFIANT
MPCI ID # ___________

(Notarization required for students who are above 18 years of age and who do not have legal guardians.)

Republic of the Philippines }

Province of Davao del Norte }s.s.
City of Panabo }

SUBSCRIBED AND SWORN TO before me this _____________________ at Panabo City, Davao del Norte,
Philippines. Affiant exhibited to me the MCPI ID as competent proof of identity.

Doc. No.: ___;

Page No.: ___;
Book No.: ___;

Series of 2019
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

REQUIREMENTS FOR WORK IMMERSION

Name

School

Course

Requirement Checklist Remarks

1. Application Letter (2 copies)
2. Bio-data with 2x2 ID Picture (2 copies)
3. MOA for Work Immersion (2 copies)
4. Rules and Regulation (2 copies)
5. Waiver/Parent Consent (4 copies)
6. Waiver for Work Immersion (4 copies)
7. Medical Certificate (2 copies)
8. Endorsement Letter (c/o school)
9. Performance Evaluation Sheet
10. Attendance Sheet

Note: Address for Application:

1. HUMSS Students
MR. ARNEL T. DUROPAN
School Principal
Sto. Niño Elementary School
Brgy. Sto. Niño, Panabo City
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

SENIOR HIGH SCHOOL UNIT

______________________________

Sir/Madam:

May I have the honor to apply for Work Immersion in your office/company/agency.

I am , years old, a resident of

___________________, and a Senior High School student of Maryknoll College of
Panabo, Inc., Sto. Niño, Panabo City, Philippines.

Looking forward for your favorable action on this application.

Very truly yours,

Work Immersion Applicant

 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

2x2
BIODATA Photo

I. Personal Data:

_________________________ ________________________ ________________________

First Name Middle Name Last Name
Address: ___________________________________________________________________
Date of Birth: _______________________ Place of Birth: ___________________________
Contact No.: ________________________ Email: __________________________________
Sex: ___________ Citizenship: ____________Weight: ___________ Height: ____________
Civil Status: _________ Religion: ___________ Parent/Guardian: _____________________
Blood Type: _______ Address: _________________________________________________
In case of emergency, please notify __________________________ Relation: ____________
Address: ________________________________________ Contact no.: ________________

II. Educational Background:

Elementary: ____________________________________ Date Graduated: ______________

Secondary: _____________________________________ Date Graduated: ______________
Tertiary: _______________________________________ Date Graduated: ______________
Technical: ______________________________________ Date Graduated: ______________
Special Skills: _______________________________________________________________

III. Employment Record

Company Address Position From To
1. ____________________ _____________________ ___________ ____________ _______
2. ____________________ _____________________ ___________ ____________ _______
3. ____________________ _____________________ ___________ ____________ _______

IV. Character References: (not related to applicant)

Name Address/Contact No Occupation

1. ___________________________ _____________________ ______________________

2. ___________________________ _____________________ _____________________
3. ___________________________ _____________________ _____________________

I certify that all the above mentioned is true and correct.

__________________________
(Signature over Printed Name)
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

SENIOR HIGH SCHOOL UNIT

I, ___________________________________________________________ have read and

understood the above Rules and Regulations of the Work Immersion Training Program. I am fully
aware that I will be responsible for any violations that I may commit.

_______________________________ _______________________________
Father’s Printed Name and Signature Mother’s Printed Name and Signature

_______________________________
Student’s Printed Name and Signature
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

RULES AND REGULATIONS FOR WORK IMMERSION TRAINEES

“When everyone obeys the rules, the shop is a much safer place in which to work than your
home”

I. ATTENDANCE, TARDINESS AND ABSENCES

- The Students under Work Immersion must observe the daily time in and out
during their core time.

II.SAFETY IN THE SHOP

- means protecting yourself and others from possible danger and injury.
III. VISITOR
- Somebody who visits during working hours is prohibited, except on emergency
cases.
IV. USE OF TELEPHONE AND OTHER FACILITIES
- Students under Work Immersion must observe the rules in using telephone and
other facilities inside the company to avoid interruptions or suspension of usual activity or
progress.
V. USE OF SUPPLIES, MATERIALS AND TOOLS
- Students under Work Immersion must be careful in using the supplies,
materials and Tools in the company/establishment to prevent damage, destroy, missing and
disappeared.
VI.PERSONALITY DEVELOPMENT
-the sum total of various qualities that are shown in behaviors. It includes
physique, intelligence, emotions, motivations, interest and social qualities.

Five Areas to Consider in Personality Development:

1. Physical Self
2. Emotional Self
3. Social Self
4. Psychological Self
5. Cultural Self

Physical Self

• Body Hygiene and Care

• Health Watch
• Self-Discipline
• Strict Observance of Biological Clock
• Nutrition
• Abstinence from certain practices

Emotional Self

This component includes a person’s;

. Likes and Dislikes
. Whether she is outgoing or shy
. Whether she is calm or nervous
. Whether she loses her temper easily or keeps her cool
Social Self

• Good manners
• Flexibility and Adaptiveness
• To do the right thing at the right time
 • Good Sense of Humor
• People-Oriented
• To act in the proper manner
• Objectivity
• Trustworthiness
• Being “Here” and “Now”

Psychological/Intellectual Self

• Congruency of Thoughts, words and Action

• Logical Rationalization
• Stress and Crises Management
• Coping with Pressures/Demands

Cultural Self/Value System

• Holding on to self as well as other’s Beliefs, Convictions, Practices and Values

• Respect for other’s Beliefs, Religion, and Practices
• Believing on the wisdom of the “Old”
• Managing individual differences
• Character

PHYSIQUE OR PERSONAL APPEARANCE (Bearing)

1. Correct body Posture (Position)

a. Attention
b. Parade Rest
c. Sitting
d. Walking

2. Grooming – includes;
a. Wearing of Uniforms/Dress
- must be in a proper way and make sure that your clothes are right for the job.
- Dangling sleeves or ties can be caught in the engine and cause serious
injury. Do not wear sandals or open-toe shoes.
b. Personal Hygiene
-Personal hygiene consists of practices, which safeguard your health and that of
others. It is often thought of as being the same as personal cleanliness. While
cleanliness is important, it is only one part of healthy living.
c. Haircut
- must be students’ haircut, 2x3, and crew cuts, skin head is prohibited.

A Philosophy of life can be summarized by three “L,S”

 LIVE- Live your life to the fullest

 LOVE- Love your family, your work, your community, your country and above all the
almighty GOD.
 LEAVE- Leave this world with a legacy for a better tomorrow.

VII. EFFECIENCY IN MEETING DEADLINES

- Students under Work Immersion are expected to do the task promptly and
comply with the assigned task. He must ask the representative for the
clarification of work if it is not clear the job or assignment.

VIII. RESTRICTED AREAS

- observed all the time to all restricted/prohibited areas in the
company/establishment.

IX. SMOKING
- smoking while handling dangerous materials such as gasoline or solvents, this
can cause a fire or explosion.
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

SENIOR HIGH SCHOOL UNIT

WORK IMMERSION ATTENDANCE SHEET

Name of Student Trainee: _____________________________________________________

Family Name Given Name Middle Name
Training Partner: _____________________________________________________________
Training Period Covered: __________________________ To _________________________
Department Assigned: ________________________________________________________
Week Number: _______________

Date Time-in Time-out Remarks

Total No. of Absences: __________________

Signed by: Checked/Verified by:

______________________________ ______________________________
Supervisor In-Charge Faculty In-Charge
 Maryknoll College of Panabo, Inc.
(Formerly Maryknoll High School of Panabo, Inc.)
National Highway, Brgy. Sto. Niño, 8105 Panabo City
Tel. No. (084) 628 – 5389
PAASCU Accredited School Level I

SENIOR HIGH SCHOOL UNIT

EVALUATION SHEETS FOR WORK IMMERSION TRAINEES

PART I. Student Name: __________________________________________________
Grade and Strand: _______________________________________________
Name of Company : ______________________________________________
Address : _______________________________________________________
No. of Hours of Training Required: ______________

PART II. (To be filled up by a Representative/supervisor where the student is deployed).

Job Factors Max. Rating to
be give Rating Rating
A. Work Performance
1. Knowledge of work (able to grasp as instructed) 10%
2. Quality of work (can cope with the demand of
additional of additional unexpected work load in a 10%
limited time)
3. Quality of work (performs an assigned job efficiently 10%
as possible)
4. Attendance (follows assigned work schedule) 10%
5. Punctuality (reports to work assignment work 10%
schedule)
B. Personality Traits
1. Physical Appearance (personally well-groomed and 5%
always wears appropriate dress)
2. Attitude towards work (always shows enthusiasm and 5%
interest)
3. Courtesy (shows respect for authority at all times) 5%
4. Conduct (observes rules and regulations of 5%
establishment)
5. Perseverance and industriousness (shows initiative 5%
and interests in work over and above what is assigned)
6. Drive and leadership (inquisitive and aggressive) 5%
7. Mental maturity (effective and calm under pressure) 5%
8. Sociability (can work harmoniously with other 5%
employees)
9. Reliability (trusted to be left alone to use or operate 5%
office/company equipment)
10. Possession of traits necessary for employment in this 5%
kind of work.
Total Rating 100%
Note: Passing Rate is 75%.

_____________________________________
Trainee’s Supervisor Signature Over Printed
Name Department Assigned: __________________________________________________
Field of Training Given: _______________________________________________________
Inclusive Date of Training: From: ______________________ To: ______________________
Total Number of Hours Rendered by the Trainee: __________________________________

Certified True and Correct:

_____________________________________
HR Personnel or Authorized Representative
Signature Over Printed Name