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
UNIQUE LEARNERS IDENTIFIER (ULI):
colored,
- - - -
passport size,
to be filled – out by the Processing Officer

white
background
Applicant’s Signature Date of Application

Name of School/Training Center/Company: BVS Colleges

Address: Km. 5, La Trinidad, Benguet, Philippines
Title of Assessment applied for: Computer System Servicing NC II
 Full Qualification  COC  Renewal
1. Client Type
 TVET Graduating Student  TVET graduate  Industry worker  K-12  OWF
2. Profile
2.1. Name:

 SURNAME A S T U D I L L O
 FIRSTNAME  R Y A N
 MIDDLE
 L U M A D C A O MIDDLE INITIAL
NAME EXTENSION
(e.g. Jr., Sr.)
NAME

Mailing
2.2.
Address: 464 Purok 3, Riverside Guisad Central
Number, Street Barangay District
Baguio City Benguet CAR 2600
City Province Region Zip Code
2.3. Mother’s Name Lourdes L. Astudillo 2.4. Father’s Name Desiderio D. Astudillo
2.5. Sex 2.6. Civil Status 2.7. Contact Number(s) 2.8. Highest Educational 2.9. Employment Status
Attainment
 Male  Single Tel: None  Elementary Graduate  Casual

 Female  Married Mobile: 09606518829  High School Graduate  Job Order

 Widow/er E-mail: [email protected]  TVET Graduate  Probationary

 Separated Fax: None  College Level  Permanent

 College Graduate  Self - Employed

None
Others:
 Others: ____________  OFW
2.10 Birth date (mm/dd/yy): M 0 M3 D2 D 4 Y 8 Y 1 2.11 Birth place: Mankayan, Benguet 2.12 Age: 42
3. Work Experience (National Qualification-related)
3.1. 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.
DepEd Baguio City Division Teacher III June 3, 2013 Present 31, 320.00 Permanent 10 years

(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
TLE/TVL CSS Crash Course Training Informatics Baguio November 26 Dec 10,17,19,20 40 Hours DepEd Baguio City Division/Informatics Baguio

(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
Licensure Examination for Teachers 2013 Baguio City 75 Passed March 24, 2024

(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: RYAN L. ASTUDILLO Tel. Number:

09606518829 PICTURE

Assessment Applied for: Computer System Servicing NC II 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

(Title of Qualification)

Name of Competency
Assessment Center:
Date of Assessment:
No. CANDIDATE’S NAME Reference Number: Signature Assessment Results
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Assessor/s: Computer System Servicing
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

___________________
(schedule of assessment) for (state title of Qualification)
_______________________________ at
________________________.
( name and address of assessment center Please report to the Assessment Center as
scheduled. )center)

 If you have any questions, please call _____________

(contact person) at _______________.
(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)
Computer System Servicing

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 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
No.
Balance
District)

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)