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:
Last First Middle
Mailing
2.2. LONE DISTRICT
Address:
Number, Street Barangay District
MTN. PROVINCE CAR
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:  Self-employed  Contractual  Regular
 Window/er e-mail :  Unemployed  Job Order  Permanent
 Separated Fax: Other than above  Temporary
Others:  Pls. specify If Student
 Trainee/OJT

3. Personal Information
3.1. Birthdate: 3.6. Weight: 3.11. Distinguishing Marks:_____________
3.2. Birth Place: 3.7. Blood Type: __________________ ___________
3.3. Citizenship: Filipino 3.8. SSS No.:
3.4. Religion: 3.9. GSIS No.:
3.5. Height: 3.10. TIN No:

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

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.

(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.
Inclusive *Certificate # of Training
Title Venue Category Conducted By Proficiency
Dates 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

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: 11.3. Occupation:
11.2. Educational Attainment: 11.4. Ave. Monthly Income:
11.5. Father’s Name: . 11.7. Occupation:
11.6. Educational Attainment: 11.8. Ave. Monthly Income:
11.9. Mother’s Name: 11.11. Occupation:
11.10. Educational Attainment: 11.12. Ave. Monthly Income:
11.13. Name of Guardian: 11.15. Occupation:
11.14. Educational Attainment 11.16. Ave. Monthly Income:
11.17. Dependents 11.18. Age Dependent Age

(For more information, indicate on a separate sheet)