TESDA-OP-CO-05-F26

Rev.No.00-03/08/17

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

APPLICATION FORM PICTURE

colored,

passport size,
REFERENCE NUMBER : ATS 2 0 0 4 3 4 1 6 3 0 0 0
Qual –
alpha
code
white
background
UNIQUE LEARNERS IDENTIFIER (ULI):
C M A - 9 9 - 2 4 4 - 0 4 0 2 1 - 0 0 1
to be filled – out by the Processing Officer

Applicant’s Signature Date of Application

Name of School/Training Center/Company: Toyota Motor Philippines School of Technology – TMP Tech.

Address: Toyota Special Economic Zone Santa Rosa Tagaytay Highway, Santa Rosa City, Laguna 4026
Title of Assessment applied for: Automotive Servicing NC IV
Full Qualification  COC  Renewal
1. Client Type
TVET Graduating Student  TVET graduate  Industry worker  K-12  OWF
2. Profile
2.
1.
Name:

 SURNAME S A L A R D A

 FIRSTNAME G E N E S I S
NAME EXTENSION
MIDDLE INITIAL
 MIDDLE NAME H U E R T O (e.g. Jr., Sr.)

2. Mailing 791 Purok 2 Santiago 3

2. Address:
Number, Street Barangay District
Malvar Batangas 4A 4233
City Province Region Zip Code
2.3. Mother’s Name: Marieneth Salarda 2.4. Father’s Name: Erwin Salarda
2.5. Sex 2.6. Civil 2.7. Contact Number(s) 2.8. Highest Educational 2.9. Employment
Status Attainment Status
 Elementary 
Male Single Tel: Casual
Graduate
 High School 
 Female  Married Mobile: 0926 890 1591 Job Order
Graduate
E-mail:
 
 Widow/er genesissalarda0807@gmail.c TVET Graduate Probationary
om

 Separated Fax: College Level Permanent
 
College Graduate Self - Employed
Others:
 Others: 
OFW
____________
Lemer
2.1 Birth date 2. Birth y, 2.1
0 7 0 9 9 8 Age:22
0 (mm/dd/yy): 11 place: Batang 2
as
3. Work Experience (National Qualification-related)
3.1. 3.2. 3.3. 3.4. 3.5. 3.6
 Status of No. of Yrs.
Name of Company Position Inclusive Dates Monthly Salary
Appointment Working Exp.

(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

(For more information, please use separate sheet)

5. Licensure Examination(s) Passed

5.1. 5.2. 5.3. 5.4. 5.5. 5.6.
Year
Title Taken Examination Venue Rating Remarks Expiry Date

(For more information, please use separate sheet)

6. Competency Assessment(s) Passed

6.1. 6.2. 6.3 6.4. 6.5. 6.6.
Qualificati
Title on Level Industry Sector Certificate Number Date of Issuance Expiration Date

(For more information, , please use separate sheet)


ADMISSION SLIP
AT
REFERENCE NUMBER : 2 0 0 4 3 4 1 6 3 0 0 0
S

Name of Applicant: Genesis Salarda Tel. Number:

Assessment Applied for: Automotive Servicing NC IV Official Receipt Number: PICTURE

Date Issued:
(Passport
To be accomplished by the Processing Officer
size)
Name of Assessment Center: TOYOTA MOTOR PHILIPPINES SCHOOL OF TECHNOLOGY – TMP TECH.

Check submitted requirements: Remarks:

Bring own Personal Protective Equipment

Accomplished Self-Assessment Guide

Three (3) pieces colored passport size pictures

 Others. Pls. specify

Assessment Date: Assessment Time: 8:00 am – 5:00 pm

JOEY GALLARDO

Printed Name & Signature of Processing Officer Printed Name & Signature of Applicant

Date: Date:
Note: Please bring this Admission Slip on your assessment date.