Technical Education and Skills Development Authority

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

NMIS FORM –01A
( For TPIS and CACS )

TRAINOR’S/ASSESSOR’S PROFILE

ID PICTURE
(2”x 2” size)

Applicant’s Signature

1. To be accomplished by TESDA
1.1. NMIS Manpower Code: - 1.2. NMIS Entry Date:

2. Manpower Profile
2.1. Name: MOTE SALAHODEN GUINAR
Last First Middle

2.2.
Mailing 0981 AMAI PAKPAK AMAI PAKPAK
Address: AVENUE PANGGAO SADUC
Number, Street Barangay District
MARAWI LANAO DEL SUR BARMM 9700
City Province Region Zip Code P.O. Box No.

2.3. Sex 2.4. Civil Status 2.5. Contact Number(s) 2.6. Employment Type 2.7. Employment Status
 Male  Single Tel:  Employed  Casual  Probationary
 Female  Married Cellular: +63918-731-7707  Self-employed  Contractual  Regular
 Window/er e-mail : [email protected]  Unemployed  Job Order  Permanent
 Separated Fax: Other than above  Temporary
Others:  Pls. specify If Student
 Trainee/OJT

3. Personal Information
3.1. Birth date: December 21, 1992 3.6. Weight: 48 kg 3.11. Distinguishing Marks:_____________
3.2. Birth Place: Marawi City 3.7. Blood Type: “O” ______________________________
3.3. Citizenship: Filipino 3.8. SSS No.:
3.4. Religion: Islam 3.9. GSIS No.:
3.5. Height: 5’1 3.10. TIN No: 447-352-276

4. Educational Background
4.1. 4.2. 4.3. 4.4. 4.5. 4.6. 4.7 4.8.
Educational Units Honors
School Level School Year Degree Minor Major Earned Received
Marawi Islamic College College 2009 2015 BSCS Programming Graduated
Iligan Computer Institute Vocational 2010 2012 Engr. Tech. Networking Graduated Honors Received
MSU – UTC Secondary 2006 2009 Secondary Graduated Honors Received
AILC Elementary 2000 2005 Elementary Graduated 3rd Honor

5. Course Title (for TPIS, CACs) 5.2. Schedule /Duration 5.3. Aptitude Exam
5.1. Schedule
*Training Duration (No. of Hrs.)
Date:
*From:
*To: Time:
For Competency Assessment and Certification Applicants Only, fill-up this part.
6. Competency Assessment to Take (to be filled-up by TESDA Representative)
6.1. Date of Application: / / 6.7. Training Program 6.8. Program Sector 6.9. Client Type
(mm) (dd) (year)  TESDA Grad.
6.2. Sector Component:  Formal  Public  Person with Disability
6.3. Trade Area:  Non-Formal  Industry  SCEP
6.4. Occupation:  Informal (prior learning)  OFW  Non-TESDA Grad.
6.5. Classification:  Other;  OFW
6.6. Competency:  Farmers; Fisherfolks
 OSY
 Others, pls. specify
Part II: The following entries can be skipped if you have previously filled up this form, except for some information that you would want to update.

7. WORKING EXPERIENCE ( For Trainers, mandatory field 7.5)

7.1. 7.2. 7.3. 7.4. 7.5. 7.6.
Occupation Type No. of Yrs.
Monthly Status of
Name of Company Position Inclusive Dates (Teaching; Non-Teaching; Working
Salary Appointment
Industrial Experience) Exp.
SGA skills institute & Assistant 01-03- Prese 1 year &
5,000 Teaching Contractual
Assessment Center Inc. Trainer 2022 nt 6 months

(For more information, indicate on a separate sheet)

8. Other Training/Seminars Attended
8.1. 8.2. 8.3. 8.4. 8.5. 8.6. 8.7. 8.8. 8.9.
*Certificate # of Training
Title Venue Inclusive Dates Category Conducted By Proficiency
Received Hours Base

(For more information, indicate on a separate sheet)

* Certificate Received Training Base Category Proficiency
A Certificate of Attendance S Skills Training Certificate L Local T Trade Skills Upgrading Program B Beginner
C Certificate of Competencies T Training Certificate F Foreign N Non-Trade Upgrading Program I Intermediate
P Certificate of Proficiency M Training Management A Advanced

9. Licenses/Examinations Passed
9.1. 9.2. 9.3. 9.4. 9.5. 9.6.
Title Year Taken Examination Venue Rating Remarks Expiry Date

(For more information, indicate on a separate sheet)

10. Competency Assessment Passed
10.1. 10.2. 10.3. 10.4. 10.5. 10.6.
Industry Sector Trade Area Occupation Classification Level Competency Specialization Description

(For more information, indicate on a separate sheet)

11. Family Background
11.1. Spouse’s Name: Rohanisah M. Hadji Shaeef 11.3. Occupation: Self-Employed
11.2. Educational Attainment: College Graduate 11.4. Ave. Monthly Income: 10,000
11.5. Father’s Name: Samad C. Mote 11.7. Occupation: Government Employee
11.6. Educational Attainment: College Graduate 11.8. Ave. Monthly Income: 12,000
11.9. Mother’s Name: Norhata G. Mote 11.11. Occupation: Housewife
11.10. Educational Attainment: Vocational 11.12. Ave. Monthly Income:
11.13. Name of Guardian: Rohanisah M. Hadji Shaeef 11.15. Occupation: Self-Employed
11.14. Educational Attainment College Graduate 11.16. Ave. Monthly Income: 10,000
11.17. Dependents 11.18. Age Dependent Age

(For more information, indicate on a separate sheet)