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: LAWAS JUDY MAE MATA
Last First Middle

2.2.
Mailing PRK.3 CENTRALA
Address:
Number, Street Barangay District
SURALLAH SOUTH COTABATO XII 9512
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: 09676404774  Employed  Casual  Probationary
 Female  Married Cellular:  Self-employed  Contractual  Regular
Lawasjudymae019@g
 Window/er
e-mail :
mail.com
 Unemployed  Job Order  Permanent
 Separated Fax: Other than above  Temporary
Others:  Pls. specify If Student
 Trainee/OJT

3. Personal Information
3.1. Birthdate: 09/19/1997 3.6. Weight: 45kls. 3.11. Distinguishing Marks:_____________
3.2. Birth Place: Surallah,South 3.7. Blood Type: ______________________________
3.3. Citizenship: Filipino 3.8. SSS No.:
3.4. Religion: Roman Catholic 3.9. GSIS No.:
3.5. Height: 147 cm 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
ELEMENTARY 2009 2010
San Isidro Elementary School
SECONDARY 2013 2014
Lambontong National High School
SURALLAH NAT”L AGRICULTURAL TERTIARY 2016 2017 DAT
SCHOOL
SULTAN KUDARAT STATE UNIVERSITY TERTIARY 2018 2019 BAT
–SURALLAH CAMPUS
SULTAN KUDARAT STATE UNIVERSITY - TERTIARY 2019 - DIT
MAIN

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
Farmers;
6.6. Competency:  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.
*Certificate # of Training
Title Venue Inclusive Dates Category Conducted By Proficiency
Received Hours Base
PEST MANAGEMENT SUNAS LOCAL SUNAS

AGRICULTURAL SUNAS LOCAL

CROPS PRODUCTION
Trainer’s Methodology SUNAS 10/30/20 12/18/20 LOCAL

(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: JENNY R. LAWAS(DECEASED) 11.7. Occupation:
11.6. Educational Attainment: HIGH SCHOOL 11.8. Ave. Monthly Income:
11.9. Mother’s Name: MILE M. LAWAS 11.11. Occupation: FARMER
11.10. Educational Attainment: HIGH SCHOOL 11.12. Ave. Monthly Income:
11.13. Name of Guardian: FELOMINO L. BARBER JR. 11.15. Occupation: BUSSINES MAN
11.14. Educational Attainment COLLEGE GRADUATE 11.16. Ave. Monthly Income:
11.17. Dependents 11.18. Age Dependent Age

(For more information, indicate on a separate sheet)