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:
Las Firs Middle
Mailin t t
g
2.2
. Address:
Number, Baranga District
Street y

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: 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.
*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)
  Public 
TESDA Grad.
6.2. Sector Component: Formal Person with Disability
6.3. Trade Area:  Non-Formal  Industry  SCEP
6.4. Occupation:  Informal (prior learn ing)  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

(For more information, indicate on a separate sheet)

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)