APPENDIX 1.

STUDENT INTERNSHIP INFORMATION SHEET

UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

COLLEGE OF ENGINEERING
PAASCU Accredited ∙ IQuAME A(t)

STUDENT INTERNSHIP INFORMATION SHEET 1X1

PICTURE

Student Trainee Information:

Name of Student: Escarro Sean John Abrasaldo

(Family Name) (Given Name) (Middle Name)
Course: BSEE Year: III
Address: Brgy. San Vicente, Binalbagan, Neg. Occ. Contact Number: 09399490504
E-mail Address: [email protected]
Mother’s Name: Maria Racquel A, Escarro Contact Number: 09283281102
Father’s Name: Genaro B. Escarro Contact Number: 09497388953

Host Training Establishment Information:

Name of Company/HTE:
Address: Contact Number:
Department in the Company assigned:
Name of Immediate Supervisor:
Contact number: E-mail Address:
Inclusive Date of Internship: from to

Name of Person to contact in case of Emergency: Genaro B. Escarro

Relationship to the student trainee: Father
Contact Numbers: 09497388953

Student’s Signature overprinted name Supervisor’s Signature overprinted name

 APPENDIX 6. WEEKLY INTERNSHIP JOURNAL

UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

COLLEGE OF ENGINEERING
PAASCU Accredited

Electrical Engineering Department

WEEKLY INTERNSHIP JOURNAL

Student Profile:
Name of Student: Contact Number:
Address: E-mail address:

Company Profile:

Name of Company Contact Number:

Company Address:
Name of Supervisor: Contact Number:
Designation: Department:
Week From: to:

DATE TIME ACTIVITIES COMPLIAN

T WITH
SUPERVISOR’S
WORK SIGNATURE
SCHEDUL
E
(YES/NO)
 DATE TIME ACTIVITIES SUPERVISOR’S
SIGNATURE

Conforme:

Student’s Signature overprinted name Supervisor’s Signature overprinted name

 APPENDIX 7. OJT CHECKLIST

UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

COLLEGE OF ENGINEERING
PAASCU Accredited

Electrical Engineering Department

OJT/PRACTICUM REQUIREMENTS CHECKLIST

Name of Student: Sean John Escarro Contact Number: 09399490504
Address: Brgy. San Vicente, Binalbagan, Negros Occidental
E-mail Address: [email protected]

For Admission:
o Have completed at least 75% of the total required units of the program

For Deployment:
o Student Enrollment Form
o Memorandum of Agreement
o Application Letter
o Recommendation Letter
o Resume
o Notarized Parent’s Consent
o Student Internship Information Sheet
o Internship Contract
o Internship Work Schedule
o Medical Certificate
o Vaccination Card (Fully Vaccinated)
o Insurance Policy (COVID-19)
o OJT Orientation Certificate of Attendance

During OJT:
o Internship Daily Time Record noted by the on-site supervisor
o Weekly Internship Journal

At the End of OJT:

o OJT/Practicum Report
o Certificate of Completion
o Student Intern Performance Evaluation
o Internship Evaluation
 APPENDIX 8. STUDENT INTERN PERFORMANCE EVALUATION REPORT

UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

COLLEGE OF ENGINEERING
PAASCU Accredited

Electrical Engineering Department

STUDENT INTERN PERFORMANCE EVALUATION REPORT

To the Supervisor:

Following is the instrument for evaluating our students. Please answer the
questions the way you would appraise their performance. You may also attach your
own instrument(s) to support your assessment on the trainee.

Name of Trainee : ___________________________________________________

Position/Line of Training : ___________________________________________________

Department : ___________________________________________________

Duration of Work : From _____________________ to _____________________

Number of Hours : ___________________________________________________

Job Description of Trainee : ___________________________________________________

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Name of Evaluator : _________________________________________________________
Position/ Office : _________________________________________________________
Company : _________________________________________________________

Please use the following rating scale: 1 = Lowest 5 = Highest

CRITERIA 1 2 3 4 5
WORK Report to work on time
ATTITUDE Accepts assigned task willingly
Completes the assigned task
Follows and observes instructions thoroughly
ENTHUSIAS Asks clarifications and explanation on company
M TO LEARN operations
Shown interest to learn
PERSONALIT Shows courtesy and respect to others
Y Wears proper work attire
Maintains workplace clean and in order
Able to work well with company personnel
SELF- Works independently without closed supervision
MOTIVATION Shows initiative on assigned tasks
SKILLS Manipulates apparatus and equipment according
to proper usage
Able to deliver assigned task according to desired
standard or quality
Additional Comments or Concerns:

Signature of Evaluator Date

 APPENDIX 9. INTERNSHIP EVALUATION

UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS

COLLEGE OF ENGINEERING
PAASCU Accredited

Electrical Engineering Department

INTERNSHIP EVALUATION

Name of Student: Sean John Escarro Contact Number: 09399490504

Training Company: BISCOM Inc.
Company Address: Brgy. San Vicente, Binalbagan, Negros Occidental
Supervisor: Contact Number:
Inclusive Date of Training: From: to: , 2022.
Date of Evaluation:

ASSIGNMENT Department:
Position/Line of Training:
Describe your duties
briefly:

What do you consider your

strongest area of
performance?
Explain.
In what areas do you feel
you have improved the
most? Explain.

In what areas do you feel

you need the most
improvement? Explain.

What situation challenged

you the most? Explain.

How did you overcome the

challenge? Explain.

What did you learn from

your experiences?
Explain.

Do you think your training

station is qualified to be
one of our university
linkages?
Explain.
Suggestions/
Recommendations:

Signature of Student Date

 This is to be filled out by OJT/Practicum Adviser

Acquired Total Training Hours:

Date of Completion:
Acquired Total Performance Rating:
Remarks:
 APPENDIX 10. INTERNSHIP PLAN

INTERNSHIP PLAN

I. INTRODUCTION:

This internship plan structures the internship program for students

enrolled in OJT/Practicum Subject developed by University of Negros
Occidental – Recoletos, College of Engineering and the Host Training
Establishment. The student interns are assigned to different areas and are
given actual work experience in various departments as stipulated in this
internship plan mutually agreed upon by the school, the HTE and the
student intern.

II. GOALS AND OBJECTIVES:

The exposure to the different work situations is provided to enable the

student intern experience and observe the practical application of theories
learned in the school.

At the end of the internship program, the students should be able to:

1. Identify key positions in the industry and related operations to their

corresponding tasks and responsibilities;
2. Define the standard operational procedure in each of the
department assigned;
3. Identify and operate the equipment, facilities and lay-out design in
each of the department assigned;
4. Perform required skills and techniques necessary in the execution of
operational procedures of the assigned tasks in accordance with the
existing workplace, health and safety standards; and
5. Analyze and evaluate operational procedure in each assigned task
and recommend any appropriate course of action to be taken to
improve procedures.

III. REQUIREMENTS OF THE PROGRAM

a. List of documents for the student internship as stipulated in OJT

Manual and CHED CMO 104 S. 2017.

i. Memorandum of Agreement
ii. Application Letter
iii. Recommendation Letter
iv. Resume
v. Student Intern Information Sheet
vi. Internship Plan
vii. Internship Contract
viii. Student must be officially enrolled in an internship subject.
ix. Student must be at least 18 years of age from the start of the
internship period
x. Notarized Written Consent from parents
xi. Medical Certificate
xii. Insurance policy
xiii. Student shall undergo required General Orientation
xiv. Monitoring and evaluation report.
b. Orientation and Briefing

After the application period, orientation and pre-internship

seminars shall be set. Training expectations, guidelines, rules and
regulations, course requirements shall be discussed. An open forum
provides a venue for clarification on certain issues. The speakers from
the Host Training Establishment may be invited to share their insights,
expectations and experiences.

c. Internship Contract

An Internship Contract is signed by the student intern, the

University and the Host Training Establishment (HTE). This agreement
identifies the student intern’s tasks and some policies regarding the
program. See Annex “A” (Appendix 12).

d. Performance

Work Plan

During the internship program the student intern shall perform

diligently his/her assigned work based on the proposed schedule of
activities and place of assignments as specified by the on-site
supervisor in the Internship Work Schedule. See Annex “B” (Appendix
5).

Evaluation Report

The student intern shall be assessed and evaluated by

accomplishing the following documents:

a. Student Intern Performance Evaluation Report. (Annex “C”)

b. Weekly Internship Journal. (Annex “D”)

At the end of the internship program the student interns are

required to evaluate the program by accomplishing the Internship
Evaluation form. See Annex “E” (Appendix 9).

e. Certification

A certification with the logo issued by the HTE issued to student

intern after the completion of the designated number of hours. The
certification bears the seal, signed by the HTE's authorized
representative.
 APPENDIX 12. INTERNSHIP CONTRACT FORMAT

INTERNSHIP CONTRACT

KNOWN ALL MEN BY THESE PRESENTS:

This INTERNSHIP CONTRACT made and executed this June, 2022 in the city
of Bacolod, by and between:

BISCOM Incorporated, a company existing under the laws of the Republic of

the Philippines with business address at Brgy. San Vicente, Binalbagan,
Negros Occidental, represented by Engr. Inmaculada F. Dael, hereinafter
referred to as the COMPANY;

- and –

Sean John A. Escarro, Filipino, of legal age, resident of Brgy. San Vicente,
Binalbagan, Negros Occidental and presently enrolled at University of Negros
Occidental – Recoletos, to complete a degree in Bachelor of Science in
Electrical Engineering, hereinafter referred to as the STUDENT INTERN.

WITNESSETH:

WHEREAS, a Memorandum of Agreement (MOA) was entered into by and

between UNIVERSITY OF NEGROS OCCIDENTAL – RECOLETOS (UNO-R) and
COMPANY on June, 2022;

WHEREAS, under the said MOA, UNO-R proposed that its students be
allowed to undergo practicum/internship at the COMPANY facilities and/or offices,
which proposal was accepted/approved by the latter, subject to terms and
conditions provided for in the MOA;

WHEREAS, STUDENT INTERN is one of the qualified students chosen by

UNO-R to undergo practicum/internship at COMPANY;

WHEREAS, the COMPANY hereby accepts the STUDENT INTERN to undergo

practicum/internship at its facilities and/or offices from June 6, 2022 to July 30,
2022

NOW, THEREFORE, for and in consideration of the foregoing premises, the

parties agree and stipulate the following:

A. The COMPANY shall endeavor to abide with the MOA it has entered into
with UNO-R.
B. The STUDENT INTERN represents and warrants that:
1. He is currently enrolled in a practicum or equivalent subject on his
fourth curricula year at UNO-R;
 2. He is at least 18 years of age;
3. He has passed pre-internship requirements;
4. He is in good academic standing and has completed all the pre-
requisite subjects;
5. He is physically, mentally, and emotionally fit and has undergone
physical and psychological examination, after which, has been
found to be such by a DOH-accredited clinic or hospital;
6. He is articulate in the language used in the COMPANY;
7. He has secured his parent/guardian’s consent to undergo practicum
at the COMPANY facilities as evidenced by the signed Parent
Consent and Waiver;
8. He has finished at least 75% of his academic requirements or has
passed and taken all his major subjects;
9. If he is a transferee or a student who has graduated or completed
another degree program and enrolled in a second program, he has
completed at least two semesters with 12 units of major subjects per
semester in UNO-R before the commencement of his training with
the COMPANY;
10. He will at all times comply with the rules and regulations of the
COMPANY, CHED and UNO-R;
11. He will complete the agreed duration of the training;
12. He has undergone the required orientation conducted by UNO- R
and the COMPANY;
13. He shall submit a monthly journal of practicum experiences
describing his training activities, problems encountered, and
reflections on the training experiences to the Faculty SIPP
Coordinator;
14. He shall respect and abide by the provisions of the MOA executed
between UNO-R and the COMPANY;

IN WITNESS WHEREOF, the parties hereof have signed this INTERNSHIP

AGREEMENT on this day of , 2022 in ,
Philippines.

BISCOM Inc.
COMPANY

By:

Engr. Inmaculada F. Dael Sean John A. Escarro

Signature of the Company Signature of the Student
Representative over printed name over printed name

Signed in the presence of:

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
BACOLOD CITY ) S.S.
x --------------------------------------------- x

BEFORE ME, a Notary Public in and for the City of Bacolod, Province of Negros
Occidental, Republic of the Philippines, on personally appeared
the following persons with their government-issued identification cards:

NAME GOVERNMENT DATE DATE PLACE

- ISSUED I.D. OF OF OF
AND NUMBER ISSUE EXPIRY ISSUE

all known to me and to me known to be the same persons who executed the
foregoing MEMORANDUM OF AGREEMENT and that the same is their free and
voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto signed this document and affixed my seal
of office on the date and place aforementioned.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of 2018.