INTERNSHIP OATH OF UNDERTAKING

I, _____________________________________, hereby attest that I have read and

understood the Internship Guidelines of the University of St. La Salle and will perform my duties
and responsibilities as a Student Intern in accordance with these guidelines.
I acknowledge my obligation to keep my Internship Coordinator informed regarding my
Internship experience for the duration of my Internship period.
I understand that I will not be issued a passing grade until I have complied with all the
requirements of the Internship Program within the specified period of time. I am aware of the
responsibilities should I commit at least one of the following violations:

REPORTED VIOLATION
1

Violation
1
of company rules
and policies

1ST OFFENSE

Falsification
2
of documents
/ Forging of Signature

Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)
Additional work hours
Referral to guidance
office for counseling
Dropped from the
course
Case conference with
DC, Dean, Coordinator,
Discipline Officer &
Parents
Counseling sessions
Page 1 of 8

2ND OFFENSE

Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Call the
parents/case
conference
with the
special
committee.
Dismissal
from the

3RD OFFENSE

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

MINOR:
3
Dishonesty
Lying, making false claims,
fabricating false
information

MAJOR:
4
Dishonesty

Logging in and not

reporting to duty, copying
someone else's term
report/cheating/deception

Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)
Additional work hours
Referral to guidance
office for counseling
Dropped from the
course
Case conference with
DC, Dean, Coordinator,
Discipline Officer &
Parents
Counseling sessions

Failure
5
to Attend
Orientation

Cannot start OJT + 50hrs

Failure
6
to meet the
deadline for endorsement

Additional 50hrs

Page 2 of 8

University.
Counseling
session
before the
release of
transfer
credentials.
Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Call the
parents/case
conference
with the
special
committee.
Dismissal
from the
University.
Counseling
session
before the
release of
transfer
credentials.

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

Non-performance
7
of
duties.
Insubordination/disregard
of supervisor's instruction.

Absence
8
Without Leave
(AWOL)

Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)
Additional work hours
Referral to guidance
office for counseling
Dropped from the
course
Case conference with
DC, Dean, Coordinator,
Discipline Officer &
Parents.
Counseling sessions

MINOR:
9
Theft/stealing
Stealing of points, taking
out office supplies

One week suspension +

50hrs duty
Counseling sessions
Restitution/Reparation

Page 3 of 8

Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Call the
parents/case
conference
with the
special
committee.
Dismissal
from the
University.
Counseling
session
before the
release of
transfer
credentials.
Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

MAJOR:
1
Theft/stealing

10

11

Dress
1 Code Violation
Inappropriate attire

12

13

Inflicting
1
or attempting to
inflict physical injury

Slander/gossiping
1

Call the parents/case

conference with the
special committee.
Dismissal from the
University.
Counseling session
before the release of
transfer credentials.
Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)
Additional work hours
Referral to guidance
office for counseling
Verbal warning
Written warning
/Reprimand
Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)

Page 4 of 8

Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

14

Utilizing
1
company facilities
for personal use

Additional work hours

Referral to guidance
office for counseling

Verbal warning
Written explanation
Case conference with
DC, Dean &
Coordinator
Case conference with
DC, Dean, Coordinator
& Parents
Conference with the
Coordinator &
Company Supervisor (to
determine whether to
keep the intern in the
same site or need to
transfer)
Additional work hours
Referral to guidance
office for counseling
Replace damaged
property
Letter of apology to the
company
Verbal warning

15

Damaging
1
company
properties

16

Selling
1
to company
employees/Soliciting
Money from company
employees. Unauthorized
solicitation of money from
company
employees/engaging in
business.

Reporting
1
to work drunk

Dropped
from the
course
Case
conference
with DC,
Dean,
Coordinator,
Discipline
Officer &
Parents
Counseling
sessions

Written
warning

Verbal warning

17

Written
warning

Page 5 of 8

Call the
parents/case
conference with
the special
committee.
Dismissal from
the University.
Counseling
session before
the release of
transfer
credentials.

Dropped from the

course
Case conference
with DC, Dean,
Coordinator,
Discipline Officer
& Parents
Counseling
sessions
Dropped from the
course
Case conference
with DC, Dean,
Coordinator,
Discipline Officer
& Parents
Counseling
sessions

18

Out
1 of place behavior:
public display of affection,
boisterous behavior,
playing with computer,
texting.

Verbal warning

Written
warning

19

Immorality.
1
Being involved
with a superior.

Dropped from the

course
Case conference with
DC, Dean, Coordinator,
Discipline Officer &
Parents
Counseling sessions

Dropped from the

course
Case conference
with DC, Dean,
Coordinator,
Discipline Officer
& Parents
Counseling
sessions

Call the
parents /
case
conference
with the
special
committee.
Dismissal
from the
University.
Counseling
session
before the
release of
transfer
credentials.

__________________________________
SIGNATURE OF STUDENT

__________________________
NAME OF COMPANY

COURSE YR & SEC: __________________

DATE: __________________

Page 6 of 8

GUARDIAN/PARENTAL CONSENT

TO WHOM IT MAY CONCERN:

I hereby willingly and voluntarily consent to the internship of my son/daughter,

_______________________________, which will be at ________________________ starting on
___________ until _________.
I have considered the benefits that my son/daughter will derive from his/her training with
the understanding that I will not hold any party responsible for any untoward accident and/or
incident which may happen to my (relationship with the intern) during the above-mentioned
activity as long as due care and precautions are observed to ensure the safety of the students.
I hereby affix my signature this _____ day of ___________ 2012.

_______________________________
Signature Over Printed Name

CONTACT #: _______________________

Page 7 of 8

INTERNSHIP INFORMATION SHEET

University of St. La Salle

1X1 or 2X2
PICTURE

DATE: _____________________

Name of Intern: _________________________________________________

(Last)

(First)

(M.I.)

Course, Year & Section: _________________

Home Address: _________________________________CP #: _________________

COMPANY NAME: ____________________________________________________
Company Address: ______________________________Tel. #: _________________
Manager/Owner: ______________________________________________________
Supervisor/Authorized Representative: ______________________ Position: _______
Department/Division: ___________________________________________________
Start Date: ________________ Expected Date of Completion: __________________
Job Description: _______________________________________________________
Schedule of working hours/days:
MON

TUE

WED

THU

FRI

SAT

AM
PM
TOTAL HRS (1 WEEK): ____________

Submitted By:

Noted By:

_____________________________
Interns Signature over Printed Name

_________________________________
Supervisors Signature Over Printed Name

Page 8 of 8