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
REFERENCE NUMBER :
Qual – YY Region Province Number Series Number Series
alpha
Assigned to AC
code
PICTURE
UNIQUE LEARNERS IDENTIFIER (ULI): colored,
- - - -
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

 FIRSTNAME 

 MIDDLE  MIDDLE INITIAL

NAME EXTENSION
(e.g. Jr., Sr.)
NAME

Mailing
2.2.
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 Status 2.7. Contact Number(s) 2.8. Highest Educational 2.9. Employment 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

2.10 Birth date (mm/dd/yy): M M D D Y Y 2.11 Birth place: 2.12 Age:

3. Work Experience (National Qualification-related)

1. 3.2. 3.3. 3.4. 3.5. 3.6
Monthly No. of Yrs. Working
Name of Company Position Inclusive Dates Status of Appointment
Salary 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.
Title Year 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.
Qualification
Title Level Industry Sector Certificate Number Date of Issuance Expiration Date

(For more information, , please use separate sheet)

ADMISSION SLIP

REFERENCE NUMBER :

Name of Applicant: Tel. Number: PICTURE

Assessment Applied for: Official Receipt Number:

(Passport
Date Issued:
size)
To be accomplished by the Processing Officer
Name of Assessment Center:

Check submitted requirements: Remarks:

 Accomplished Self-Assessment  Bring own Personal Protective Equipment

Guide

 Three (3) pieces colored passport size pictures

 Others. Pls. specify

Assessment Date: Assessment Time:

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

BREAD AND PASTRY PRODUCTION NC II

Name of Competency Assessment

Center:
Date of Assessment:
Assessment
No. CANDIDATE’S NAME Signature
Results
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

_______________
Date
___________________
___________________
___________________

Dear Sir/Madam:

This letter officially appoints you as competency assessor on

___________________ for _______________________________ at
(schedule of assessment) (state title of Qualification)

________________________. Please report to the Assessment Center as

( name and address of assessment center )center)
 scheduled.

If you have any questions, please call _____________ at _______________.

(contact person) (phone number)

We look forward to your acceptance of this appointment.

Very truly yours,

______________________
AC Manager

Conforme:

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

REQUEST FORM FOR ASSESSMENT PACKAGE/S

TITLE OF QUALIFICATION

NAME OF ASSESSMENTCENTER

DATE OF ASSESSMENT

NUMBER OF CANDIDATES FOR

ASSESSMENT

REQUESTED BY
(PO CAC Focal)


DATE OF REQUEST

APPROVED BY
(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 BREAD AND PASTRY PRODUCTION NC II at CAMIGUIN PROVINCIAL
TRAINING CENTER. 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-SOP-CO-07-F28
Rev.No.01-07/20/15

Reference No. Q alpha AC number

Year Region Province
code series Number series
To be filled out by the Competency Assessor
Competency Assessment Results Summary (CARS)-TESDA copy
Candidate Name:
Assessor Name:
Title of Qualification/ Cluster of
Units of Competency
Assessment Center: Date of Assessment:

The performance of the candidate in the following unit(s) of competency and corresponding
assessment methods. Not
Satisfactory
Satisfactory
Unit of Competency Assessment Method

1.

2.

3.

4.

5.

Note: Satisfactory Performance shall only be given to candidate who demonstrated successfully all the competencies identified in
the above-named Qualification/Cluster of Units of Competency.
 For submission of
Recommendation  For issuance of NC/COC Additional documents
For re-assessment (pls. specify)
(Indicate title/s of COC, if Full Qualification is not met) ______________________
____________________________________ Specify:___________
_______________ ______________________
____________________________________

Did the candidate overall performance meet the required evidences/standards?  Yes  No
OVERALL EVALUATION  Competent  Not Yet Competent

General Comments [Strengths/Improvements needed] packet

Candidate signature: Date:
Assessor signature: Date:
Name & Signature of AC
Date:
Manager

CANDIDATE’S COPY (Please present this form when you claim your NC/COC)
PICTURE
COMPETENCY ASSESSMENT RESULTS SUMMARY
for NC
Reference No.
(To be put in a
Name of Candidate: Date Issued: packet)
Title of Qualification/ Cluster of (Do not staple or
Units of Competency paste)
Name of Assessment Center: Date of
Assessment:
Assessment Results:  Competent  Not Yet Competent
 For issuance of NC/COC  For submission of Additional  For re-assessment
Recommendation: (Indicate title/s of COC, if Full Qualification is not met) documents. Specify: (pls. specify)

Assessed by: ______________________ Attested by: ____________________

Name/s and Signature Name and Signature of
Assessment Center Manager
Date: Date:
 TESDA-OP-CO-05-F35
Rev.No.00-03/08/17

LETTER OF DESIGNATION

_______________

Date

___________________
___________________
___________________

Dear ________________:

This letter officially designates _____________________________ as

assessment venue for BREAD AND PASTRY PRODUCTION NC II) on DECEMBER
20, 2024). 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 ____________________

QUALIFICATION PROVINCE
TITLE
NAME OF ASSESSOR ASSESSMENT CENTER DATE OF
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 itinakdang
panuntunan)
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 opinyon
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
QUALIFICATION ASSESSMENT RECEIPT OF PRINTING CANDIDATE NC/ COC BY THE
NAME CARS BY THE OF 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 _____________________________ of legal age, Filipino, single/
married and with address at ____________________________________, 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 __________________________________; and

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

Issued on ___________________, 20____ at _____________________.

__________________________
Signature of the Certified Worker

__________________________
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)