Republic of the Philippines

Bulacan State University

City of Malolos, Bulacan

College of Science

On-The-Job Training Program

Performance Evaluation Report
Student Trainee ____________________________________________ Age________ Sex __________
Course __________________________________________Major ______________________________
Name of Firm ___________________________________ Address _____________________________
No. of Training Hrs. Required ________ _____________Total Hrs. Rendered ___________________
Job Assigned _________________________________________________________________________
______________________
Signature
Max. rating to
be given

CRITERIA
1. Quality of work (thoroughness, accuracy, neatness and
effectiveness)
2. Quantity of work (able to complete work in allotted time)
3. Dependability, reliability and resourcefulness (ability to work with
minimum amount of supervision)
4. Judgment (sound, decisions, ability to identify and evaluate
pertinent factors)

RATING

20%
20%
10%
10%

5. Cooperation (works well with everyone, good item work)

10%

6. Attendance (regularity and punctuality in office attendance and

proper observation of break period)

10%

7. Personality (personal grooming and pleasant disposition)

10%

8. Safety (awareness of safety practices)

10%
TOTAL RATING: ________

Recommendation for trainers future growth:

_____________________________________________________________________________________
_____________________________________________________________________________________
Evaluated by:
_____________________
Name and Signature

Noted by:
_____________________
Name and Signature

_____________________
Designation

_____________________
Designation

Republic of the Philippines

Bulacan State University
City of Malolos, Bulacan

College of Science
W A I V E R
I, _______________________________________ of legal age, single/married, and residing at
__________________________________________________through the request of the Bulacan State
University and __________________________________________
(Firm/ Company)
And in consideration thereof, hereby freely and voluntarily assume and impose upon myself the following
duties;
That I recognize the authority of the _______________________________________________
(Firm/ Company)
under whom I am placed and submit myself to the rules and regulations that maybe imposed in
connection with my training;
That I assume full responsibility to all damages incurred by me arising out of and in course of my
training during off hours;
Furthermore, I renounce and waive any all claims against the Bulacan State University and
________________________________________ for any injury that may sustain or any loss that I
(Firm/ Company)
may suffer, personal or pecuniary, in the performance of my duties or functions.
Signed at City of Malolos, Bulacan this _____day of _____ 2012.
_____________________
Signature
Witnesses:
_____________________
_____________________
CONFIRMATION
That we ________________________________ of legal age, Filipino and a resident of
________________________________ after being duly sworn in accordance with law hereby agree and
state:
That we hereby confirm the above waiver appearing in this instrument.
________________________________
Signature of Parents/ Guardians
Subscribe and sworn to before me this ___________ day of ___________2012 affiant exhibiting
his/her residence certificate No. _________ issued at ___________ on __________.

________________________
(Administering Officer)

Republic of the Philippines

Bulacan State University
City of Malolos, Bulacan

College of Science
STUDENT INFORMATION SHEET
PERSONAL DATA:
Name: _______________________________________________________________________________
Status: _____________________ Course: ______________________________ Year: _______________
Nationality: __________________________________________________________________________
Major: _____________________________ __Length of Course in Years: _________________________
City Address: ___________________________ ________Tel no./ Mobile no. ______________________
Prov. Address: __________________________ ________Tel no./ Mobile no. ______________________
Date of Birth: __________________________________ Place of Birth: __________________________
Age:________
Sex: ________
Height: ________
Weight: ___________
Physical Disability, if any: _______________________________________________________________
FAMILY BACKGROUND:
Fathers Name: __________________________________ Occupation: ___________________________
Mothers Name: _________________________________ Occupation:____________________________
Address of Parents: ___________________________________Tel no./ Mobile no. _________________
SCHOOL DATA:
Name of School _______________________________________________________________________
Training Coordinator: _________________________________ Tel no./ Mobile no. _________________
Training Coordinator: _________________________________ Tel no./ Mobile no. _________________
School Address: _______________________________________________________________________
Head of School: _______________________________ _______Tel no./ Mobile no. _________________
IN CASE OF EMERGENCY, NOTIFY:
Name: ___________________________________________ Relationship: ________________________
Address: ___________________________________________ Tel no. ___________________________

I HEREBY CERTIFY THAT THE INFORMATION STATED ABOVE ARE

TRUE AND CORRECTED TO THE BEST OF MY KNOWLEDGE AND BELIEF.
________________________
1x1 photo

Signature of Student

________________________
Print Name of Student
Date Accomplished: ______________________