Dole Form 1n6u1y

Republic of the Philippines Department of Labor and Employment Bureau of Labor Standards Manila APPLICATION FOR SPECIAL CERTIFICATE TO EMPLOY LEARNER OR APPRENTICE WITHOUT COMPENSATION AS A REQUIREMENT OF A SCHOOL CURRICULUM OR AS A PRE-REQUISITE TO A BOARD EXAMINATION. ____________________________________________________________________________ ________________________________________________________________ This application must be accompanied by a certification from the school attended by the apprentice stating the number of hours of On-the-Job Training required the curriculum course being taken. Attached recent photo of apprentice. Application not fully accomplished shall not be entertained. ______________________________________________________________________ Commission on Audit- Department of Education 1. Name of Establishment _________________________________________________ Sindalan, City of San Fernando, Pampanga 2. Address of Location ____________________________________________________ . Anne Camille P. Alfonso 3. Name of Proposed Apprentice/Student-Trainee ______________________________ Holy Angel University 4. Name of Institution _____________________________________________________ On-job-training 5. Nature of Training _____________________________________________________ November 2015 to January 2015 6. Period of Training _____________________________________________________ 4 to 8 hours 7. Number of Hours to be spent daily ________________________________________ The undersigned certifies that the information given above is true and correct and tat the employment of the above-named apprentice will not prejudice the existing office personnel of the establishment and that the picture attached is that of apprentice; and that the said practice/training will not be a ground for employment on any position that may become vacant in the future. ___________________________ Signature of the Employer Over Printed Name ___________________________ Designation ___________________ Signature of Apprentice Address

___________________________ Date