Republic of the Philippines

Central Mindanao University

University Town, Musuan, Maramag, Bukidnon, Philippines 8710
Mobile No: 09177721154 E-mail: Cheryl_daleon@yahoo.com

Civil Engineering Department – College of Engineering

LIABILITY WAIVER

I, ___________________________, a student of Central Mindanao University, hereby voluntarily agree to

undergo “on-the-job training” in any educational institution/industry or establishment in order to acquire work
experience related to the academic training gained from the Civil Engineering Department under the
following terms and conditions:
1. That I shall abide all the company policies and shall comply with those imposed for the program;
otherwise, I shall be excluded from further participation;
2. That I shall exercise care and diligence in any task assigned to me;
3. That I shall renounce and waive my claim against school/industry/establishment for any injury
I suffer, personal or pecuniary, in the performance of my duties or function while under the
training in the event of any unforeseen circumstances beyond human control:
4. That I shall be made answerable for any and all liabilities for damages of property or injury to
a third person which may be occasioned by my intentional or neglect act while in the course of
my training;
5. That is fully understood by me that there is no employer-employee relationship between me
and the company.

Signed on this _____ day of ______________________ 2018 at ________________________________

______________________, Philippines.

________________________________
Signature of Student

Res. Cert. No. ____________________

Issued on: _______________________
Issued at: _______________________
With our consent and approval:

_______________________________ ________________________________
Signature Signature

_______________________________ ________________________________
Name of Parent Name of School Representative

Res. Cert. No. ____________________ Res. Cert. No. ____________________

Issued on: _______________________ Issued on: _______________________
Issued at: _______________________ Issued at: _______________________

SUBSCRIBED AND SWORN TO ME BEFORE this _______ day of June ________ 2018 at __________
__________________________________, Philippines.