TESDA-OP-CO-05-F26

Rev.No. 00-03/01/17

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

APPLICATION FORM
REFERENCE NUMBER: Passport
Alpha YY Region Province Number Series Assigned Number Series Code to AC Size (3.5cm
UNIQUE LEARNERS IDENTIFIER (ULI): x 4.5cm)
- - - - colored ID
Picture
to be filled – out by the Processing Officer white
background
___________________________ _________________________
Applicant’s Signature with collar
Date

Name of School/ Training Center/ Company:

Address:
Title of Assessment Applied for:
□ Full Qualification □ COC □ RENEWAL
1. Client Type
□ TVET Graduating □ TVET Graduate □ Industry Worker □ K-12 □ On-site (abroad)
Student
2. Profile
2.1 Name:
SURNAME
FIRST NAME
Middle
MIDDLE NAME Initial
NAME EXTENSION(e.g Jr.,
Sr.)
2.2 Mailing Address:

Number, Street
Barangay District

Municipality/City Province
Region Zip Code
2.3 Mother’s Name: 2.4 Father’s Name:
2.5 Gender 2.6 Civil Status 2.7 Contact Number 2.8 Highest Educational 2.9 Employment
(s) Attainment Status
□ Male □ Single Tel:_________________ □ Elementary graduate □ Casual
□ Female □ Married Mobile: _______________ □ HS graduate □ Contractual
□ Widow/er E-mail: ________________ □ TVET graduate □ Job Order
□ Separated Fax: __________________ □ College level □ Probationary
Others: _______________ □ College graduate □ Permanent
__________________ □ Self-Employed7
Course: ________________ □ OFW

2.1 Birth 2.1 Birth Place 2.12 Age

0 Date 1
mm/dd/
yy
3. Work Experience (National Qualification-related)
Name of Company 3.2 3.3 3.4 3.5 3.6
Position Inclusive Dates Monthly Status of Appointment No. of Yrs. (Working
Salary Experience)

(For more information, please use separate sheets)

4. Other Training/Seminars Attended (National Qualification-related)
4.1 Title 4.2 Venue 4.3 Inclusive Dates 4.4 No. of Hours 4.5 Conducted by

(For more information, please use separate sheets)

5. Licensure Examination(s) Passed
5.1 Title 5.2 Year Taken 5.3 Examination Venue 5.4 Rating 5.5 Remarks 5.6 Expiry Date

For more information, please use separate sheets)

6. Competency Assessment(s) Passed
6.1 Title 6.2 Qualification Level 6.3 Industry Sector 6.4 Certificate Number 6.5 Date of Issuance 6.6 Expiration Date

For more information, please use separate sheets)

ADMISSION SLIP
REFERENCE NUMBER: 2 0 0 2 1 5 0 0

Name of Applicant: Tel. Number:

Assessment Applied for: Official Receipt Number:
Date Issued:
 Passport
To be accomplished by the Processing Officer Size (3.5cm
Name of Assessment Center: x 4.5cm)
Check submitted requirements: Remarks:
colored ID
□ Accomplished Self-Assessment Guide (SAG) □ Bring own Personal Protective Equipment
□ Three (3) pieces colored passport size pictures □ Others. Pls. specify _____________________________ Picture
Assessment Date: Assessment Time: white
background
with collar

________________________ _______________________________
Printed Name & Signature of Processing Officer Printed Name & Signature of Applicant
Date: Date:
Please bring this Admission Slip on your Assessment date
Sample Attendance Sheet

Technical Education and Skills Development Authority

National TVET Trainers Academy

Name of Assessment Center

Date

Name Signature

Assessor ACAC Manager

Sample COMPETENCY ASSESSMENT AGREEMENT

Candidate’s Name:

Assessor’s Name:

Qualification: RAC SERVICING (PACU/CRE) NC II

BASIC UNITS

Units of Competency to be
Assessed: • Participate in Workplace Communication
• Work in Team Environment
• Practice Career Professionalism
• Practice Occupational Health and Safety Procedures
COMMON UNITS
• Perform mensuration and calculation
• Prepare materials and tools
• Observes procedures, specifications and manual of
instruction
• Perform basic benchwork
• Perform basic electrical works
• Maintain tools and equipment
• Perform housekeeping and safety practices
• Document work accomplished
CORE UNITS

• Survey site for installation

• Install PACU/CRE
• Install PACU/CRE piping systems
• Install PACU/CRE electrical systems
• Service and maintain PACU/CRE units
• Troubleshoot PACU/CRE systems
• Recover and recycle refrigerant in PACU/CRE systems
• Repair and retrofit PACU/CRE systems and its
accessories
• Perform start-up and commissioning for PACU/CRE
systems

YES NO

• Have the context and purpose of assessment been explained?

• Have the qualification and units of competency been explained

 • Do you understand the assessment procedure and evidence to
be collected?
• Have your rights and appeal system been explained?
• Have you discussed any special needs to be considered during
assessment?
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.

Candidate’s Signature: Date:

Assessor’s Signature: Date:

 Competency Assessment Result Summary

Candidate’s Name:

Assessor’s Name:

Title of Qualification / Cluster of

Units of Competency

Assessment Center: Date:

The performance of the candidate in the following unit(s) of competency and

Satisfactory Not Satisfactory
corresponding methods

Units of Competency

1.

2.

3.

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

Recommendation: ❑ For issuance of NC/COC ❑ For submission of

additional documents
❑ For re-assessment (pls.
specify)
(Indicate title 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]

Candidate’s signature: Date:

Assessor’s signature: Date:

Assessment Center Manager

Date:
Signature: