Sample Data Gathering Instrument for Trainee’s

Characteristics
JAT CAREER DEVELOPMENT INC.
Area 1 Calabuanan Baler Aurora

DOMESTIC WORK NC-II

NAME: JEM R. MARZAN

Please answer the following instrument according to the characteristics

described below. Encircle the letter of your choice that best describes you as
a learner. Blank spaces are provided for some data that need your response.

Characteristics of Learners
Language, Literacy Average grade in English: Average grade in Math:
and numeracy a. 95 and above a. 95 and above
(LL&N b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
e. 75 to 79 e. 75 to 79
Cultural and a. Ilocano
Language b. Tagalog
Background c. Other (please specify) __________________
Education and Highest Educational Attainment
General Knowledge a. High School level
b. High School Graduate
c. College level
d. College Graduate
e. With unit in Master’s Degree
f. Masteral Graduate
g. With unit in Doctoral Level
Sex a. Female
b. Male
Age 39

Physical ability a. Disabilities (if any)

b. Existing Health Conditions
c. None
Illness/sickness a. Asthma
b. Heart disease
c. Hypertension
d. Diabetes
e. Others (please specify)
f. None
Previous experience 1. Certificate of employment
with the topic 2. Training certificate
 3. Diploma
Previous learning List down trainings related to domestic work NC II
experience 1. Cookery
2. Bread and Pastry
Training level National certificate to the NC level
completed
NONE
Special courses Other related courses

NONE

Characteristics of Learners
Learning Style a. Visual (Spatial) - Visual learners are those who
prefer learning by observing things. Using
pictures, images, diagrams, whiteboards and
more helps these types of learners understand
information better. These students can easily
visualize information, have a good sense of
direction and usually likes to draw and doodle. 

b. Aural (Auditory ) - Sound and music are a

strong suit for these types of learners who
typically have a good sense of rhythm. These
learners are usually singers or musicians who
are familiar with different instruments and the
sounds they make. Aural learners are good
listeners who normally learn best through
verbal presentations like lectures and speeches

c. Verbal (Linguistic) .- These learners prefer

using words, both in speech and writing. They
can easily express themselves and usually love
to read and write. Verbal learners tend to have
a vast vocabulary and excel in activities that
involve speaking, debating, and journalism.

d. Physical (Kinaesthetic) - Whether it’s by using

their body or hands, these learners are all
about the sense of touch. Physical activities
and sports play a big part in these student’s
lives. Getting hands-on is a must for these
learners who love to tinker and learn best when
they can do rather than see or hear. 

e. Social (Interpersonal) - Learning in groups and

 working with others is favored by social
learners. These students know how to
communicate effectively and enjoy collaborating
with others, brainstorming and discussing
ideas and concepts. Social learners are
generally good listeners who are thoughtful and
understanding.

f. Solitary (Intrapersonal ) - These students prefer

to use self-study and work alone. They are
independent and are very self-aware and in
tune with their thoughts and feelings. These
learners prefer being away from the crowds and
learn best in a quiet place where they can focus
on the task at hand

Other Needs a. Financially challenged

b. Working student
c. Solo parent
d. Others (please specify)

JEM R. MARZAN
Trainee

JOCELYN A. TIBLE
Trainer
FORM 1.1 SELF- ASSESTMENT CHECK
JAT CAREER DEVELOPMENT INC.
Area 1 Calabuanan Baler, Aurora

DOMESTIC WORK NC-II

NAME: JEM R. MARZAN

INSTRUCTION: This self check instrument will give the trainer necessary
data or information which is essential in planning training sessions. Please
check the appropriate box of your answer to the question below.

BASIC COMPETENCIES
CAN I? YES NO
1. Participate in workplace communication
1.1Obtain and convey workplace information 

1.2 Complete relevant work related documents 

1.3 Participate in workplace meeting and discussion 

2. Work in a team environment

2.1.Describe and identify team role and responsibility in a team 

2.2. Describe work as a team member 

3. Practice career professionalism

3.1 Integrate personal objectives with organizational goals 

3.2 Set and meet work priorities 

3.3 Maintain professional growth and development 

4. Practice occupational health and safety

4.1 Evaluate hazard and risks 

4.2 Control hazards and risks 

4.3 Maintain occupational health and safety awareness 

COMMON COMPETENCIES
CAN I? YES NO
1. Maintain an effective relationship with clients/ customer
1.1 Maintain a professional image 

1.2 Build credibility to meet customers/clients requirements 

2. Manage own performance

2.1 Plan completion of own workload 

2.2 Maintain quality of own performance 

CORE COMPETENCIES

CAN I? YES NO

1. Clean living room, dining room, bedrooms, toilet and kitchen

1.1 Use of appropriate cleaning equipment, supplies and 
materials
1.2 Clean surfaces, floors, furniture and fixtures 

1.3 Make up beds and cots 

1.4 Clean toilet and bathroom 

1.5 Clean kitchen area, utensils/table appointments and kitchen 

appliances
1.6 Provide supplies for dining room, living room, bedroom and 
bathroom/toilet
1.7 Maintain clean and sanitize room environment 

CORE COMPETENCIES

CAN I? YES NO

2. Wash and iron clothes linen and fabric

2.1 Check and sort soiled clothes, linen and fabric 

2.2 Prepare washing equipment and supplies 

2.3 Perform laundry o

2.4 Dry clothes, linen and fabric 
 2.5 Iron clothes, linen and fabric 

2.6 Maintain regular housekeeping and maintenance of

laundry area and equipment
3. Prepare hot and cold meals/food

3.1 Prepare ingredients according to recipes o

3.2 Check “Mise en Place” 

3.3 Cook soup as per menu 

3.4 Cook vegetable dishes as per recipe 

3.5 Cook meat/poultry, fish/ seafood dishes as per culinary 

method
3.6 Cook egg dishes as per client’s preference 

3.7 Cook pasta, grain and farinaceous dishes as per recipe 

3.8 Garnish cooked dishes 

3.9 Prepare appetizers as per requirement or client’s 

preference
3.10 Prepare sauces as per recipe 

3.11 Prepare cold desserts 

3.12 Prepare pastry desserts o

3.13 Prepare sandwiches 

3.14 Store dry and liquid ingredients 

4. Provide food and beverage service

4.1 Prepare dining area 

4.2 Set-up table 

4.3 Serve food and beverage 

4.4 Clear table 

NOTE: In making the self- check for your Qualification, all required
Evidence/ Proof
competencies of Current
should Competencies
be specified. It is therefore required of a trainer to be
well- versed of the CBC or TR of the program qualification He/she is teaching.
Jem R. Marzan Jocelyn A. Tible
Trainee Trainer

Form 1.2 Evidence of Current Competencies acquired related to

Job/Occupation

Name of Trainee: JEM R. MARZAN

Current Proof / Evidence Means of Validating

Competencies

BASIC
Participate in Evaluate the validity and
workplace Employment certificate authenticity of the
communication document presented
Work in a team Evaluate the validity and
environment Training certificate authenticity of the
training certificate
presented
Practice career Evaluate the validity and
professionalism Employment certificate authenticity of the
employment certificate
presented
Practice occupational Evaluate the validity and
health and safety Training certificate authenticity of the
training certificate
presented

COMMON
Maintain an effective Evaluate the validity and
relationship with Employment certificate authenticity of the
clients/ customer employment certificate
presented
Manage own Certificate of Skills test
performance achievement

CORE
Clean living room,
dining room, bedrooms, NONE NONE
toilet and kitchen
Wash and iron clothes Training certificate Evaluate the validity and
linen and fabric authenticity of the
training certificate
presented
Prepare hot and cold Training certificate Evaluate the validity and
meals/food authenticity of the
training certificate
presented
Provide food and Training certificate Evaluate the validity and
beverage service authenticity of the
training certificate
presented
Identifying Training Gaps

From the accomplished Self- Assessment Check (Form 1.1) and the
evidences of current competencies (Form – 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.

Form 1.3 Summary of Current Competencies Versus Required

Competencies (sample)
Name: Jem R. Marzan

Required Units of Current Training

Competency/Learning Competencies Gaps/Requirements
Outcomes based on TR
BASIC COMPETENCIES

Participate in workplace communication

Obtain and convey workplace Obtain and convey
information workplace
information
Complete relevant work related Complete relevant
documents work related
documents
Participate in workplace Participate in
meeting and discussion workplace meeting
and discussion

Work in a team environment

Describe and identify team role Describe and
and responsibility in a team identify team role
and responsibility
in a team
Describe work as a team Describe work as a
member team member

Practice career professionalism

Integrate personal objectives
with organizational goals
Set and meet work priorities
Maintain professional growth
and development
Integrate personal
objectives with
organizational goals
Set and meet work
priorities
Maintain
professional growth
and development

Maintain professional growth and development

Evaluate hazard and risks Evaluate hazard
and risks
Control hazards and risks Control hazards
and risks
Maintain occupational health Maintain
and safety awareness occupational health
and safety
awareness
COMMON COMPETENCIES

Maintain an effective relationship with clients/ customer

Maintain a professional image Maintain a
professional image
Build credibility to meet Build credibility to
customers/clients meet
requirements customers/clients
requirements

Manage own performance

Plan completion of own Plan completion of
workload own workload
Maintain quality of own Maintain quality of
performance own performance

CORE COMPETENCIES

Clean living room, dining room, bedrooms, toilet and kitchen

Use of appropriate cleaning Use of appropriate
equipment, supplies and cleaning equipment,
materials supplies and
materials
Clean surfaces, floors, Clean surfaces,
furniture and fixtures floors, furniture and
fixtures
Make up beds and cots Make up beds and
cots
Clean toilet and bathroom Clean toilet and
bathroom
Clean kitchen area, Clean kitchen area,
utensils/table appointments utensils/table
and kitchen appliances appointments and
kitchen appliances
Provide supplies for dining Provide supplies for
room, living room, bedroom dining room, living
and bathroom/toilet room, bedroom and
bathroom/toilet
Maintain clean and sanitize Maintain clean and
room environment sanitize room
environment

Wash and iron clothes linen and fabric

Check and sort soiled clothes, Check and sort
linen and fabric soiled clothes, linen
and fabric
Prepare washing equipment Prepare washing
and supplies equipment and
supplies
Perform laundry Perform laundry
Dry clothes, linen and fabric Dry clothes, linen
and fabric
Iron clothes, linen and fabric Iron clothes, linen
and fabric
Maintain regular housekeeping Maintain regular
and maintenance of laundry housekeeping and
area and equipment maintenance of
laundry area and
equipment

Prepare hot and cold meals/food

Prepare ingredients according Prepare ingredients
to recipes according to recipes
Check “Mise en Place” Check “Mis en Place”
Cook soup as per menu Cook soup as per
menu
Cook vegetable dishes as per Cook vegetable
recipe dishes as per recipe
Cook meat/poultry, fish/ Cook meat/poultry,
seafood dishes as per culinary fish/ seafood dishes
method as per culinary
method
Cook egg dishes as per client’s Cook egg dishes as
preference per client’s
preference
Cook pasta, grain and Cook pasta, grain
farinaceous dishes as per and farinaceous
recipe dishes as per recipe
Garnish cooked dishes Garnish cooked
dishes
Prepare appetizers as per Prepare appetizers
requirement or client’s as per requirement
preference or client’s preference
Prepare sauces as
Prepare sauces as per recipe per recipe
Prepare cold
Prepare cold desserts desserts
Prepare pastry
Prepare pastry desserts desserts
Prepare sandwiches Prepare sandwiches
Store dry and liquid Store dry and liquid
ingredients ingredients

Provide food and beverage service

Prepare dining area Prepare dining area
Set-up table Set-up table
Serve food and beverage Serve food and
beverage
Clear table Clear table

Form No.1.4 Training Needs

Name: Jem R. Mazan

Using Form No. 1.4, convert the Training Gaps into a Training Needs/
Requirements. Refer to TR in identifying the Module Title or Unit of
competency of the training needs identified.

Training Needs Module Title / Module of

(Learning Outcomes) Instruction
 Use of appropriate cleaning
equipment, supplies and
materials.

 Clean surfaces, floors,

furniture and fixtures.

 Clean surfaces, floors,

furniture and fixtures.

Cleaning living room, dining room,

 Make up beds and cots bedroom, toilet and kitchen

 Clean toilet and bathroom

 Clean kitchen area,

utensils/table appointments
and kitchen appliances.

 Provide supplies for dining

room, living room, bedroom,
bathroom and toilet
 Maintain clean and sanitize
room environment.