Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

PRE-DEPLOYMENT SURVEY FORM

Instructions:
This survey will serve as a guide for OJT Coordinators to identify the student-trainees preferred
industries for possible deployment. This shall be accomplished and submitted a semester before the
deployment period. Please seek the help of your relatives, friends and acquaintances to recommend
possible industries considering the safety, integrity of the industry & benefits among others.
Name of Student:-Trainee STEPHANIE MAE P. BAYTA Course/Yr./& Section: BSOA -3A______
Sex: ________ Religion: _______________ Date of Birth: ____________Place of Birth: ______________
Age: ________ Contact Numbers: Landline No. ______________ Cell Phone No. __________________
Address:
Provincial: ________________________________________________________________
City: _____________________________________________________________________
Name of Parents / Guardian:
Father: _______________________________________ Signature: ________________
Date of Birth: __________________________________ Occupation: _______________
Mother: _______________________________________ Signature: ________________
Date of Birth: __________________________________ Occupation: _______________
DIRECTIONS: Check the box as to your industry preference for your On-the-Job Training and fill-out the
form with complete information.
First preference (different cities within the Bicol -DTI Accredited Industry or company)
Second preference (different municipalities of the six provinces of the Bicol Region DTI accredited)
Third preference (cities and provinces outside the Bicol Region. DTI Accredited Industries)
PREFERRED INDUSTRY:
Name of Industry: ______________________________________________________________________
Address: ______________________________________________________________________________
Contact Person: ________________________________________________________________________
Department____________________________________________________________________________
Tel. No.: ___________________ Tele Fax No.:____________________ E-Mail:______________________
REASON FOR THE PREFERENCE____________________________________________________________
______________________________________________________________________________________

____________________________
NAME OF STUDENT-TRAINEE
(Signature over Printed Name)

_____________________________
PARENT/ GUARDIAN
(Signature over Printed Name)

Date:___________________

Date:____________________

Effectivity Date: February 2013

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

PARENTS PERMIT
TO WHOM IT MAY CONCERN:
This is to certify that I MRS. HERMINIA P. BAYTA parent/guardian of STEPHANIE MAE P. BAYTA____
a student-trainee of CAMARINES SUR POLYTECHNIC COLLEGES, Nabua Campus, Nabua, Camarines Sur grants
permission to undergo On-the-Job Training at _______________________ from __________ to ______________. I
understand and agree that the training is a necessary component of the__________________________ curriculum
and more importantly I, as a parent/guardian should refrain sending them for an errand or for anything else causing
him/her get absent from the training.

further

affirm

that

CAMARINES

SUR

POLYTECHNIC

COLLEGESNabua

Campus,

and

the_______________________________ are in no way responsible nor shall pay compensation for any accident,
harm, injury that may cause on his/her person during the training. Furthermore, my son/daughter/ward will undergo
said actual On-the-Job Training with or without compensation from either the CAMARINES SUR POLYTECHNIC
COLLEGESNabua Campus or the _______________________________________.

I also certify that he/she on his/her own free will signified to me his/her decision to undergo On-the-Job
Training as evidenced by his/her signature below together with my signature.

______________________________________
Name and Signature of Parent/Guardian
Date: ________________

______________________________________
Name and Signature of Student-Trainee
Date: ________________

______________________________

______________________________

Name and Signature of Witness

Name and Signature of Witness

Address: ______________________

Address: ______________________

Date: _________________________

Date: _________________________

Effectivity Date: February 2013

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

OJT/ICT TRAINING LIABILITY WAIVER

I, STEPHANIE MAE P. BAYTA a student-trainee of Camarines Sur Polytechnic College, Nabua

Campus, Nabua, Camarines Sur, voluntarily agree to undergo On-the-Job/In-company Training,
which is an academic requirement for graduation of the CSPC, Nabua Campus, under its
______________________ Program, state the following terms and conditions:
1. That I shall abide by all the industry/companys rules and regulations and shall comply with
those imposed for the training otherwise I shall be disqualified from further participation;
2. That there is no labor-management relationship between the corporation

and me;

3. That I shall exercise care and diligence in any task assigned to me;
4. That I shall renounce and waive any claim against __________________________ and
the Camarines Sur Polytechnic Colleges for any loss that I suffer personal or pecuniary, in
the performance of my duties or functions while under training; and,
5. That I shall be made answerable for any and all 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 training.
________________________________
Name and Signature of Student-Trainee
Residence Certificate No._____________
Issued at _________________________
Issued on_________________________

WITH OUR CONSENT AND APPROVAL:

_____________________________
Name /Signature of Parent /Guardian

_______________________________________
Name /Signature of OJT/ICT Program Coordinator

Residence Certificate No._________ Residence Certificate No.________________

Issued at _____________________ Issued at ____________________________
Issued on_____________________ Issued on____________________________

SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of _____________ 2014

Nabua, Camarines Sur, Philippines.

____________________________
Administering Officer

Effectivity Date: February 2013

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

TRAINING AGREEMENT
1. The purpose of this training agreement is to a.) Define clearly the conditions and the
schedule
of
training.
b.)
to
serve
as
guide
to
the
Industry
Partner_______________________ and assistance to Camarines Sur Polytechnic
Colleges (CSPC) Nabua Campus in providing the students with opportunities for training
the occupational competences and the technical information related to it.
2. In order that the systematic plan which provides for well- rounded training can be followed,
a schedule of work experience that will interface what was taught in the college have been
worked out and agreed upon by the Industry Partner and the College Representative.
3. The On-theJob training is designed to run for ____ weeks with a minimum of 40 hours
per week.
4. The student trainee agrees to perform diligently the work experience assigned to him/her
by the Industry Partner. The student-trainee also agrees to pursue faithfully the prescribed
course of study and to take advantage of the opportunity to improve his/her efficiency,
knowledge and personal traits so that they may enter his chosen occupation as a desirable
employee at the end of the training period.
5. The student-trainee while on the process of training will have the status of student trainee
neither displacing a regular worker presently employed nor substituting for a worker
needed by the Industry Partner.
6. The training period begins on _____________________________________ and extended
up to_______________________.
7. The Industry Partner is responsible to give due and appropriate evaluation of the
performance of the student-trainee and recommends to the schools selection and awards
committee for due recognition of any outstanding / excellent performance, if any.
8. Industry partners shall evaluate the conduct and performance of the student-l trainee l
through the OJT/ICT Coordinator.
9. The OJT/ ICT Coordinator shall have authority to transfer or withdraw the student-trainee
anytime with proper protocol. (If a student- trainee wants to transfer, seek official written
request and clearance from the industry and present it to the Industry Mentor for proper
and official endorsement)
10. The On-the-Job/In-Company-Training (OJT/ICT) of the student- trainee shall conform to all
rules and regulations stipulated and agreed upon by both parties.

______________________________
Name and Signature of Student-Trainee
Representative
______________________________
Name and Signature of Parent
(Witness)

______________________________
Name and Signature of the Industry

________________________________
Name and Signature of OJT/ICT Coordinator
(Witness)

Date: ________________________

Noted:
PROF. EMILDA E. ESCOLANO
Name and Signature of Dean

Effectivity Date: February 2013

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

Students Evaluation Form

College of Management and Entrepreneurship-BSOA
Name_____________________________________________

Course___________________

Name of Agency/Firm/Industry____________________________
Address________________________________________________
Please use the rating scale below in grading the apprentice/trainee:
99-100-1.0
90-92 - 1.75
81-83 - 2.5
73-74- 3.15
96-98 - 1.25
87-89- 2.0
78-80 - 2.75
71-72 - 4.0
93-95 - 1.5
84-86- 2.25
75-77 -3.0
65-70 - 5.0
_____________________________________________________________________________________
WEIGHT
RATING
_____________________________________________________________________________________
I. ABILITY TO PERFORM THE WORK (30%)
Accuracy
_____________:_____________
Volume/ Quantity
_____________:_____________
General Ability .
_____________:_____________
_________________________________________________________
II. KNOWLEDGE OF THE WORK (20%)
Extent of knowledge of the work
_____________:_____________
Ability to understand and followInstructions ..
_____________:_____________
Knowledge of departments Operations .
_____________:_____________
_________________________________________________________
III. WORK ABILITY AND PERSONALITY (30%)
Punctuality ..
_____________:_____________
Attendance .
_____________:_____________
Deportment (Self-control,
Courtesy alertness)..
_____________;_____________
Interest in doing the work..
_____________:_____________
Habit of being productiveand avoiding idleness
_____________:_____________
Cooperative and willing to assist others ..
_____________:_____________
Loyalty to companys interest
_____________:_____________
Orderliness (techniques of procedure/ care of tools/
equipment
_____________:_____________
________________________________________________________
IV.SPECIAL QUALITIES (20%)
Initiative/ Originality.
_____________:_____________
Judgement..
_____________:_____________
Adaptability
_____________:_____________
Trustworthiness
_____________:_____________
TOTAL
100%
________________________________________________________
GENERAL AVERAGE ..

_____________:_____________

Remarks:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
OVER-ALL PERFORMANCE EQUIVALENT
7-11 8-31

5.0

4.0

32-35 36-40

41-44 45-49

50-53 54-58

59-62 63-66

3.00

2.5

2.00

1.50

2.75

2.75

Score ___________________
Equivalent ______________

Effectivity Date: February 2013

1.75

1.25

67-70

1.00

_____________________________

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

Company Supervisor

Republic of the Philippines

Camarines Sur Polytechnic Colleges
Nabua Campus

Student Evaluation for OJT Coordinators

Direction: This is a student-trainee evaluation of their respective OJT Coordinators in relation to
the duties and functions and to be submitted to the Dean/ VPAEA together with the clearance at
least a week before the scheduled graduation. This will help concerned OJT Coordinators/Deans
to identify the areas that need to be addressed to improve the program. . Thank you for your
sharing your expertise and time.
Part I. Profile of the OJT Coordinator:
Name: ______________________________________________ Age: _____ Sex:_____
Program: ___________________________
Term (Sem / SY) ____________________

Part II. Profile of the Student-Trainee:

Name of Student-Trainee:_______________________________ Age:____
Sex:_____
Course: ______________________________
Specialization__________________________
Training Period: Date Started: ________________ Date Completed: ___________________

Part III. Performance Evaluation of OJT Coordinators

I. Performance Indicators:
(Please rate your OJT Coordinator based on the rating scale below by checking the
appropriate column.)
5- Outstanding

4 Very Satisfactory 3 Satisfactory

2 Need Improvement

5
A. Effectiveness ( Was able to plan, organize, monitor student

4
4

1 Poor

trainees based on the calendar of activities / action plan/ targets agreed

upon).
B. Problem Solving and Decision Making ( Evaluates situations
objectively and proposes / considers un/conventional solutions/
to problems).
C. Communication ( Uses appropriate language when interacting with
student-trainees/ industry mentors/representatives).

D. Professional Skills ( Is reliable, respects opinions, accepts

constructive criticism from others).
E. Efficiency ( distributes/ retrieves pre/on/post training documents and

Effectivity Date: February 2013

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
(054) 288-4421 loc. 128

CSPC-F-COL-29
CME File Code: 1.7.1.18

coordinates with industry/company before deployment).

Effectivity Date: February 2013

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