Annex “A”
Form A. INTERNSHIP APPLICATION FORM
Part 1.
PERSONAL INFORMATION
Full Name SHERWIN GERALD S. AGUSTIN
Date of Birth MAY 24, 2003 Age 21 Sex MALE
Place of Birth MANILA Citizenship FILIPINO
Address: BITAG GRANDE, BAGGAO, CAGAYAN
Landline No. N/A Cell Phone No. 09656642871
Name of Academic Institution CAGAYAN STATE UNIVERSITY – CARIG CAMPUS
Name & Position of OJT Coordinator ENGR. REZEL A. STO. TOMAS
Degree/Level (Grade/Year): THIRD YEAR COLLEGE
ADDITIONAL INFORMATION
Special Skills CREATIVITY
Areas of Interest HARDWARE DESIGNING
Competencies PROBLEM SOLVING
PLACEMENT DETAILS
Put a check mark on the organizational unit where you wish to do internship
Project Offices (NBP, NGDC, Admin. and ✓ Regional Office
Free Wifi Finance Service
ICT Literacy and Competency ✓ Cybersecurity Executive Offices
Development Bureau
Provincial Offices ✓ Procurement Legal Service
Service
By signing below, I certify that the statements I have made in this application are correct to the best of
my knowledge and belief; and that I agree to meet the eligibility requirements for the Internship
Program. Submission of incorrect information may lead to strict legal action and may forfeit my
internship under the Department of Information and Communications Technology.
SHERWIN GERALD S. AGUSTIN JULY 01, 2024
Signature of Applicant over Printed Name Date
Part 2: Essay Question. Please answer with not more than 50 words.
Why choose DICT for your internship program?
I CHOSE DICT BECAUSE I WANT TO LEARN MORE ABOUT SATELLITES AND IT WAS
RECCOMENDED BY OUR HIGHER YEARS.
Part 3. Essay question. Please answer with not more than 50 words.
What competencies do you expect to gain from your internship with DICT and how will you
apply the competencies acquired?
EFFECTIVE COMMUNICATION WITH MY TEAMS TO COLLABORATE EFFECTIVELY
AND PRESENT IDEAS CLEARLY.
FOR DICT USE ONLY
Date Initials
Curriculum Vitae
Medical Insurance or Medical Certificate indicating that the OJT
Applicant is physically fit;
Form A-C
Endorsement Letter
MOA (from school/optional)
Accomplishment Report and Timesheet
Post Internship Evaluation Form (by the Immediate Supervisor)
Apprenticeship Program Evaluation Form (by the Trainee)
Annex “B”
Form B. WORK PLAN FORM
Intern Name:SHERWIN
Full Name: SHERWIN GERALD S. AGUSTIN
Internship Details:
Typical tasks performed by the interns include:
(Extracted from the Enhanced Internship Guidelines, DO No. 118 dated April 28, 2022, No. 1.2 of the 1. POLICIES AND PROCEDURES)
● conduct of research;
● document writing and preparation;
● catalog and systematic organization of information;
● assistance in the organization of conferences, forums, or other collaborative
events;
● collation of knowledge stories/best practices; and
● other tasks that may be assigned by the Supervisor.
Duration of Internship: 240 HOURS
The intern hereby undertakes to abide by all the applicable laws and regulations prescribed
by the appropriate agency including the internal rules and regulations of the DICT.
Conforme:
SHERWIN GERALD S. AGUSTIN RICA V. CASUGA
Intern OJT Coordinator, DICT R2
ENGR. REZEL A. STO. TOMAS
OJT Coordinator
Annex “C”
Form C. WORK ASSIGNMENT AND SCHEDULE FORM
Intern’s Name: SHERWIN GERALD S. AGUSTIN
Week Monday Tuesday Wednesday Thursday Friday
1-6 8:00 am - 5:00 pm
RICA V. CASUGA
OJT Coordinator
(Signature over Printed Name)
