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
code
Assigned to AC PICTURE
LEARNERS IDENTIFIER (ULI):
UNIQUE 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 Distr
ict

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  Casual
Graduate
 Female  Marrie Mobile:  High School  Job Order
d Graduate
 Widow/er E-mail:  TVET Graduate  Probationary

 Separate Fax:  College Level  Permane

d nt
 College  Self -
Others: Graduate Employed
 Others:  OFW
2.10 Birth date M M D D Y Y 2.11 Birth 2.1 Age:
(mm/dd/yy): place: 2
.
3. Work Experience (National Qualification-related)
3.2. 3.3 3.4. 3.5. 3.6
Monthl No. of Yrs.
Name of Company Position Inclusive Dates Status of
y Working Exp.
Appointment
Salary
(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 Rating Remarks Expiry Date
Venue

(For more information, please use separate sheet)

6. Competency Assessment(s) Passed

6.1. 6.2. 6.3 6.4. 6.5. 6.6.
Qualificatio
Title n 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 Remarks:

requirements:

 Accomplished Self-  Bring own Personal Protective

Assessment Guide Equipment

 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
Date: Assessment
 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:
No. CANDIDATE’S NAME Reference Signature Assessment
Number: Results
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Assessor/s:
TESDA Representative:

Signature over Printed

Signature over Printed Name
Name Accreditation Number:

AC Manager:
Signature over Printed
Signature over Printed Name
Name Accreditation Number:
 TESDA-OP-CO-05-F28
Rev.No.01-09/02/22

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

(_sc_he_d_ul_e for (state title of Qualification) at
_ _ _
of a sse ss_ _ _
m en t)
_( n_a_m_e _an_d_a_dd_r_ess of_a_ss_e_ss_m_e_nt_ce_n_te_r _. Please report
to the Assessment Center as
scheduled.

If you have any questions, please call (_co_n_ta_ct_p_er_so_n_) _ at

( p_h_o n_e_n_um_b_e_r ) .
We look forward to your acceptance of this

appointment. Very truly yours,

Provincial

Director 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 ( 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

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
Accomplished
Respondent
[Pls. Tick (🗸) where applicable]
 ACAC Manager  Candidat
e
INSTRUCTIONS: Put a tick (🗸) mark in the appropriate column
5– Very Satisfactory 3 – Good
SCALE GUIDE 1–
4 – Satisfactory 2 – Fair
Poor
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

*Frequenc
y 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 Recipient Inclusive Serial No. Spoilage

Quantity Date No. Quantity Availabl
Name of Form Received Receive
(Province/
District) Issued Seria e
d From To From To Qty
l No. Balanc
e

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 CANDIDATE
PO NC/COC
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)