TESDA-OP-CO-05-F26

Rev. 00 – 03/01/17

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

 APPLICATION FORM
PICTURE
REFERENCE NUMBER :
Qual – YY Region Province Number Series Number Series
colored,
alpha
code Assigned to AC

UNIQUE LEARNERS IDENTIFIER (ULI): passport

size,
- - - -
to be filled – out by the Processing Officer

Applicant’s Signature Date of Application

Name of School/Training Center/Company:

Address:

Title of Assessment applied for:
 Full Qualification  COC  Renewal
1. Client Type
 TVET Graduating Student  TVET graduate  Industry worker  K-12  OWF
2. Profile
2.
1.
Name:

 SURNAME
 FIRSTNAM 
E
 MIDDLE  MIDDLE INITIAL
NAME EXTENSION
(e.g. Jr., Sr.)
NAME
2. Mailing
2. Address:
Number, Street Barangay District

City Province Region Zip Code

2.3. Mother’s Name 2.4. Father’s Name
2.5. Sex 2.6. Civil 2.7. Contact Number(s) 2.8. Highest Educational 2.9. Employment Status
Status Attainment
 
 Male  Single Tel: Elementary Graduate Casual
 
 Female  Married Mobile: High School Graduate Job Order
 
 Widow/er E-mail: TVET Graduate Probationary
 
 Separated Fax: College Level Permanent
 
College Graduate Self - Employed
Others:
 
Others: ____________ OFW
2.1 Birth date 2.1 Birth 2.1
M M D D Y Y Age:
0 (mm/dd/yy): 1 place: 2
3. Work Experience (National Qualification-related)
3.1. 3.2. 3.3. 3.4. 3.5. 3.6
Monthly Status of No. of Yrs.
Name of Company Position Inclusive Dates
Salary Appointment Working Exp.
(For more information, please use separate sheet)

4. Other Training/Seminars Attended (National Qualification-related)

4.1. 4.2. 4.3. 4.4 4.5
Title Venue Inclusive Dates No. of Hours Conducted By

(For more information, please use separate sheet)

5. Licensure Examination(s) Passed

5.1. 5.2. 5.3. 5.4. 5.5. 5.6.
Year
Title Taken Examination Venue Rating Remarks Expiry Date

(For more information, please use separate sheet)

6. Competency Assessment(s) Passed

6.1. 6.2. 6.3 6.4. 6.5. 6.6.
Qualificati
Title on Level Industry Sector Certificate Number Date of Issuance Expiration Date

(For more information, , please use separate sheet)


ADMISSION SLIP
REFERENCE NUMBER : BCN 1 8 1 2 8 0 0 2 2 0 0 0

Name of Applicant: Tel. Number: PICTURE

(Passport
Assessment Applied for: Official Receipt Number:
size)
Date Issued:
To be accomplished by the Processing Officer
Name of Assessment Center:

Check submitted requirements: Remarks:

 Bring own Personal Protective

 Accomplished Self-Assessment Guide
Equipment
 Three (3) pieces colored passport size pictures
 Others. Pls. specify

Assessment Date: Assessment Time:

Emelda Rose C. Silvestre

Printed Name & Signature of Processing Officer Printed Name & Signature of Applicant
Date: Date:

Note: Please bring this Admission Slip on your assessment date.

 TESDA-OP-QSO-02-F07
Rev.No.00-03/01/17

Reference No.
to be filled out by the Processing Officer

SELF ASSESSMENT GUIDE

Qualification:
Units of Competency
Covered:
Instruction:
 Read each of the questions in the left-hand column of the chart.
 Place a check in the appropriate box opposite each question to indicate your
answer.
Can I? YES NO

I agree to undertake assessment in the knowledge that information gathered will only
be used for professional development purposes and can only be accessed by
concerned assessment personnel and my manager/supervisor.

___________________________________ Date:
Candidate’s Name & Signature

Evaluated by:
_______________________________  Qualified for Assessment
AC Manager
 Not yet Qualified for Assessment
Date:
 TESDA-OP-CO-05-F31
Rev.No.00-03/08/17

Technical Education and Skills Development Authority

ASSESSMENT AND CERTIFICATION PROGRAM

ATTENDANCE SHEET

(Title of Qualification)

Name of Competency
Assessment Center:
Date of Assessment:
Reference
No. CANDIDATE’S NAME Signature Assessment Results
Number:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Assessor/s:
TESDA Representative:
__________________________________
Signature over Printed Name ______________________________
Signature over Printed Name
Accreditation Number:_______________

AC Manager:
__________________________________
Signature over Printed Name ______________________________
Signature over Printed Name
Accreditation Number:_______________
 TESDA-OP-CO-05-F28
Rev.No.00-03/08/17

Technical Education and Skills Development Authority

ASSESSMENT AND CERTIFICATION PROGRAM

LETTER OF APPOINTMENT

July 20, 2018

Ma. Theresa Hervias

Teacher Village, Fatima
General Santos City

Dear Sir/Madam:

This letter officially appoints you as competency assessor on August 02-


03-06 , 2018 for BEAUTYCARE (NAILCARE) NC II at NIMER EDUCATIONAL
INSTITUTE AND TECHNOLOGY, INC.. Please report to the Assessment
Center as scheduled.

If you have any questions, please call EMELDA ROSE C. SILVESTRE at

553 2092. We look forward to your acceptance of this appointment.

Very truly yours,

MELODY D. NIMER
NEIATECH-AC Manager

Conformed:

_____________________
Signature of Assessor
 TESDA-OP-CO-05-F30
Rev.No.00-03/08/17

REQUEST FORM FOR ASSESSMENT PACKAGE/S

TITLE OF QUALIFICATION BEAUTY CARE (NAILCARE) NC II

NAME OF ASSESSMENTCENTER NIMER EDUCATIONAL INSTITUTE

AND TECHNOLOGY, INC.

DATE OF ASSESSMENT AUGUST 08-10 , 2018

NUMBER OF CANDIDATES FOR 25

ASSESSMENT

REQUESTED BY RUTH SHEEBA P. CANZANA

(PO CAC Focal)


DATE OF REQUEST JULY 25, 2018

APPROVED BY ENGR. RICHARD M. AMPARO

(Provincial Director)

DATE APPROVED
 TESDA-OP-CO-05-F29
Rev.No.00-03/08/17

LETTER OF ASSIGNMENT

_________________
Date

___________________
___________________
___________________

___________________:

This letter officially designates you as TESDA Representative on (__Date

__) for ( Title of Qualification ) at ( name and address of AC/AV
). Please report to the Assessment Center/Venue as scheduled.

If you have any questions/ queries, please call the undersigned at

telephone number/s ______________.


Very truly yours,

____________________
Provincial Director

Conforme:

_____________________
Signature over printed name
of TESDA Representative
 TESDA-OP-CO-05-F34
Rev.No.00-03/08/17

REPORT ON ASSESSMENT PROCEEDINGS

Name of Competency
Assessment Center
Accreditation Number
Title of Qualification
Date of Assessment No. of Candidates
Name of Competency Assessor
Findings and Observations:
Items Yes No Areas for Improvement
1. Competency Assessor has a signed Letter of
Appointment
2. Attendance of the candidates is checked and
Admission Slips are verified and collected
3. Supplies and materials are available during the
conduct of assessment
4. Tools and equipment are available and in good
working conditions
5. Assessment starts on time
6. Conduct of assessment is in accordance with the
methods identified in the CATs
 7. Projects produced by the candidates are in accordance
with the requirements in the CATs.
8. Candidates are provided with clear and constructive
feedback on the assessment decision (one-on-one)
9. Assessor has the ability to manage the competency
assessment proceedings
10. Complaints of candidates are properly addressed and
handled by the Assessor & the AC, when applicable
11. Assessment Packages issued to the Assessor are
completely returned upon completion of assessment
12. Assessment-related documents are accurately
accomplished and submitted promptly after assessment
 Rating Sheets
 CARS
 Attendance Sheet
 RWAC
 Application Forms with SAGs
 Assessor’s Guide & Specific Instruction to Candidate
Narrative: (Recommended areas for improvement of items which are not covered or named above)

Prepared by: Date:

____________________________________ _____________________
Signature over Printed Name (TESDA Rep)
 TESDA-OP-CO-05-F35
Rev.No.00-03/08/17

LETTER OF DESIGNATION

_______________

Date

(Head of TVI/ Company)________

___________________
___________________

Dear ________________:

This letter officially designates __(NAME OF TVI/ Company) as assessment

venue for (TITLE OF QUALIFICATION) on (DATE OF ASSESSMENT). Conduct of
assessment shall be governed by Procedures Manual on Competency Assessment.

We look forward to your acceptance of this agreement.

Very truly yours, Approved by:

___________________ _____________________
AC Manager TESDA Provincial Director

CONFORME:

___________________
Head, TVI/ Company
 TESDA-OP-CO-05-F36
Rev.No.00-03/08/17

ASSIGNMENT OF ASSESSORS
For the month of ____________________

QUALIFICATIO PROVINCE
N TITLE
DATE OF
NAME OF ASSESSOR ASSESSMENT CENTER
ASSESSMENT

TESDA-OP-CO-05-F37
Rev.No.00-03/08/17
 Performance Evaluation Instrument
Assessor’s Name
Qualification
Date
Name of Respondent
Accomplished
[Pls. Tick () where applicable]
 ACAC Manager  Candidate
INSTRUCTIONS: Put a tick () mark in the appropriate column

5– Very Satisfactory 3 – Good

SCALE GUIDE 1 – Poor
4 – Satisfactory 2 – Fair
RATING
ITEM
5 4 3 2 1
1. Physical appearance and composure
(Pangkalahatang anyong pisikal at kung paano magdala sa sarili)
2. Ability to pace instruction
(Kakayahang magpaliwanag ng malumanay at mahusay kung ano ang mga dapat gawin)
3. Ability to establish good rapport with candidates
(Kakayahang magpadaloy ng komunikasyon sa pagitan niya at ng mga kukuha ng pagsusulit)
4. Ability to ensure that the candidate understands the instruction
(Kakayahang siguraduhing ang lahat ng instruksyon ay naiintindihan ng mga kukuha ng pagsusulit)
5. Ability to answer querries, comments, etc.
(Kakayahang magbigay ng karapat dapat nasagot o tugon sa mga tanong, puna o mga paglilinaw)
6. Ability to establish the assessment context and purpose of assessment
(Kakayahang magpaliwanag tungkol sa layunin ng pagsusulit)
7. Ability to plan and prepare the evidence gathering process
(Kakayahang paghandaan at iayos ang mga pangangailangan sa pagsusulit)
8. Ability to provide allowable/reasonable adjustments in the assessment procedure
(Kakayahang magbigay ng makabuluhang konsiderasyon sa may Mga pangangailangan sa pagsusulit)
9. Ability to conduct assessment in accordance with the methodologies
(Kakayahang ipatupad ang pagsusulit ayon samga itinakdanpanuntunan)
10. Ability to collect appropriate evidence during the conduct of assessment
(Kakayahang mangalap at sumuri ng mga tamang ebidensya habang nagbibigay ng pagsusulit
11. Ability to provide clear and constructive feedback on the assessment decision
(Kakayahang magbigay ng malinaw at tamang kaukulang opinion sa resulta ng pagsusulit)
12. Ability to provide fair, reliable and valid assessment decision
(Kakayahang magbigay ng pantay, ugma at tamang desisyon sa resulta ng pagsusulit)
Sub - score

FINAL RATING
Signature of Respondent

FOR TESDA USE ONLY

EVALUATOR’S REMARKS:

RECOMMENDATION:
 YES
For re-accreditation  For further review
 NO
*Frequency
For AC Manager – once a month
For Candidate - at least 2 candidates per assessment schedule
 TESDA-OP-CO-05-F38
Rev.No.00-03/08/17

UTILIZATION REPORT ON BLANK CERTIFICATES ISSUED

REGION ___________________

Inclusive Serial No. Recipient Inclusive Serial No. Spoilage

Quantity Date Quantity Available
Name of Form Received Received
(Province/ Serial
From To Issued From To Qty Balance
District) No.

Prepared by: Signature: Date:

Certified Correct: (Regional Director) Signature: Date
 TESDA-OP-CO-05-F42
Rev.No.00-03/08/17
TRACKING SHEET
PREPARATION AND ISSUANCE OF CERTIFICATE
For the month of ____________________
TITLE OF DATE OF DATE OF DATE OF SIGNATURE OF DATE OF RECEIPT OF
NAME QUALIFICATION ASSESSMENT RECEIPT OF PRINTING OF CANDIDATE NC/ COC BY THE
CARS BY THE NC/COC CANDIDATE
PO
LAST NAME FIRST NAME MI

Prepared by: Noted by:

Name & Signature Provincial Director

 TESDA-OP-CO-05-F27
Rev.No.00-03/08/17

LETTER OF AUTHORIZATION

I, ________________________, of legal age, Filipino, single/married with

address at____________________________________, do hereby name, constitute
and appoint EMELDA ROSE C. SILVESTRE of legal age, Filipino, single/ married and
with address at STA. MARIA SCHOOL , JP LAUREL ST. DADIANGAS NORTH,
GENERAL SANTOS CITY, to be my true and lawful attorney, for me and in my name,
place and stead, to perform the following acts and things, to wit:

1. To claim my Certificate in MASSAGE THERAPY NC II; and

2. To sign all documents necessary for the conduct of said transaction.

Issued on _______________, 2017 at General Santos City.

__________________________
Signature of the Certified Worker

EMELDA ROSE C. SILVESTRE

Authorized Representative
(Signature over Printed Name)

___________________________________________________________________

For TESDA use only

I hereby attest that the claimant presented the following:

Original copy of CARS

 Photocopy of ID of the certified worker
Accreditation ID of claimant (if Liaison Officer)
Photocopy ID of claimant

__________________________________
TESDA PO CAC Focal person
(Signature over Printed Name)
 NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY, INC.
2nd Floor New Kaman Building, J. Catolico Avenue , General Santos City
TELEPHONE : (083) 553-2092 EMAIL ADD : [email protected]

July 18, 2018

ENGR. RICHARD M. AMPARO

Provincial Director
TESDA XII – SARGEN
General Santos City

ATTENTION: RUTH SHEBA P. CANZANA

Assessment Focal
TESDA – SARGEN

Dear Sir:

The NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY , INC., would like to request for
NATIONAL COMPETENCY ASSESSMENT in BEAUTYCARE (NAILCARE) NC II on August 02-03-
06 , 2018. A TWSP-2018 of Beautycare (Nailcare) NC II.

Here under attached is the list of candidate.

1. KESIAH DEGUILMO AMANTE

2.JU-ANN MAXIMINO BALLEQUE
3.BJY TABON BANDALAN
4.MERCEL ARANCON BUHAT
5.JOYCEL JOY GENON CUATON
6.CHERYLL NARVAEZ DEL ROSARIO
7.JANELLE ANNE ESTENOTE DILAG
8.AILEN JOY LAPURA ESLERA
9.KIMBERLY BATUIGAS FUNTILON
10.FEARLYN JOY ESPALLANGAR GREGORIO
11.RHEU-VEN NECESARIO ILUSTRISIMO
12.JOHN BRYAN RICANOR JAMERO
13.HEZEKIELAH MARIANNE JOIE D JOSOL
14.LOU-NIEL CASTILLION MANGLICMOT
15.KAYE DENISE SALVA MEJARES
16.GERRY . MONTUYA Jr
17.AJARRA JAIDI MUSA
18.ROTHEL GRACE SIBUMPAN OMABE
19.EMARLENE SOLATORIO QUIBOD
20.AILEEN JOY RAMIREZ SALVANI
21.REYJANE MAE PADUAL SANTILLANA
22.AUBREY MANANSALA SAYAS
23.JOANADEN PANCHO BATUIGAS
24.RUSSEL SARMIENTO TORZAR
25.HONEY LEE MONTERDE ZABALA

Very Truly Yours,

MELODY D. NIMER
NEIATI-AC MANAGER
NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY, INC.
2nd Floor New Kaman Building, J. Catolico Avenue , General Santos City
TELEPHONE : (083) 553-2092 EMAIL ADD : [email protected]

July 18, 2018

ENGR. RICHARD M. AMPARO

Provincial Director
TESDA XII – SARGEN
General Santos City

ATTENTION: RUTH SHEBA P. CANZANA

Assessment Focal
TESDA – SARGEN

Dear Sir:

The NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY , INC., would like to request for
NATIONAL COMPETENCY ASSESSMENT in BEAUTYCARE (NAILCARE) NC II on August 05-06-
07 , 2018. A TWSP-2018 of Beautycare (Nailcare) NC II.

Here under attached is the list of candidate.

01.EIFER JEAN FLORES AMBON

02.RENA MIE . AMBONG
03.REGEN ARACANI AMOGUIS
04.CYREL VON ATUGAN AYAP
05.PRINCES PALAING BELTRAN
06.ALAIZA TIMBAO BRAQUEL
07.ROSALINDA DIZON BULALA
08.LALEINE SANZA CALAGAHAN
09.JOVALYN CEREÑO COBACHA
10.JOCELYN DAYONDON CRIDO
11.KISHIA AMOR ABABOL DELA CRUZ
12.IVY MAE NEPOMOCENO DELIMA
13.ELLEN JOY SANICO DORMIDO
14.BABY JEAN TAGALOG GARING
15.JULIET DELOSO GUID
16.KAREN JILL GALANG ISUGA
17.JESIREE . LALIC
18.MARY JOY ABERGONZADO LAURENTE
19.ABEGAIL VANZUELA MAGTUBO
20.SHILOH HIOLEN MILLAN
21.DECERRIE JANE LAGANTE PILON
22.JENIE ROSE CAÑETE RICABLANCA
23.KRISTINE CHANTAL DEOCAMPO SAREÑO
24.JOSHUA ABELANTAR SOLLANO
25.NORAJEAN TABORA TAUDI

Very Truly Yours,

MELODY D. NIMER
NEIATI-AC MANAGER
NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY, INC.
2nd Floor New Kaman Building, J. Catolico Avenue , General Santos City
TELEPHONE : (083) 553-2092 EMAIL ADD : [email protected]

July 18, 2018

ENGR. RICHARD M. AMPARO

Provincial Director
TESDA XII – SARGEN
General Santos City

ATTENTION: RUTH SHEBA P. CANZANA

Assessment Focal
TESDA – SARGEN

Dear Sir:

The NIMER EDUCATIONAL INSTITUTE AND TECHNOLOGY , INC., would like to request for
NATIONAL COMPETENCY ASSESSMENT in BEAUTYCARE (NAILCARE) NC II on August 08-09-
10 , 2018. A TWSP-2018 of Beautycare (Nailcare) NC II.

Here under attached is the list of candidate.

1. MARYJANE PUGOY ABAN

2.MARIEL COMIGHOD ALIMENTO
3.DALEE LACSAROM MAG ASO
4.KARIZ JANE DALIG ATANG
5.APRIL ABAN BAGUIO
6.FRECHE ABAN BAG UIO
7.MIRA LACSAROM CAMARISTA
8.CHRISTINE MAE DEYPUYART DATOY
9.MAR JOY ROSIDO DE ASIS
10.MARLYN TANG DIAZ
11.VIVIAN SUAN DUMANIG
12.TEOFILA PEROLINO MAGDAYO
13.JULINDA SONGCOG MIRAMONTE
14.LADY ANN PANES NAVARRO
15.ALLEN BAHAY OCHEVILLO
16.ELNIE MORANTA ORDENIZA
17.ROSEMARIE JAMERLAN OLARTE
18.DORENA NATCHER OLIVEROS
19.ROSE MARIE JAYAWON PALAPAR
20.REYJEAN AVELINO PANTARAS
21NOEME FENANDEZ PORALAN
22.RHEA MAE MORCISA RAMITAN
23THERESA MAE DE VERA RIVERA
24CATHERINE SALAZAR SALINAS
25DIVINE ROSE CAPILLO TIMBOGAN

Very Truly Yours,

MELODY D. NIMER
NEIATI-AC MANAGER