TESDA-OP-CO-04-F16

Rev.No.00-03/08/17

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

Address _____________________
Tel. No.______________________

APPLICATION FORM
COMPETENCY ASSESSOR’S ACCREDITATION

SECTOR CONSTRUCTION TITLE OF QUALIFICATION SCAFFOLDING WORKS (SUPPORTED TYPE) NCII

Last Name G O N G O R A

First Name J A N N I K O L A I MI D.

Complete Address LOT 8 BLK 5 LANGKA ST. DIVIDEND HOMES SUBD., BRGY. SAN JUAN, TAYTAY, RIZAL
Email add janniolaigongora@gmail.com
Date of Birth(mm/dd/yyyy) 11 18 1993 Place of Birth CAINTA, RIZAL Height: (m) 1.72m Weight: (k) 85kg

Employer / Company MUNICIPALITY OF CAINTA Tel. No 696-2602

Address CAINTA MUNICIPAL HALL A.BONIFACIO AVE., BRGY.STO.DOMINGO, CAINTA, RIZAL
Position/ Inspector (Scaffolding Works) No. of years in the 7 No. of years in
Designation position industry
7
Highest Educational
Sex Civil Status Contact Number(s) Employment Status
Attainment
 
☑ Male ☑ Single Tel: TVET graduate  Casual Permanent
  Mobile
09772419786  College level  Contractual ☑ Self-employed
Female Married phone:

 Window/er e-mail : jannikolaigongora@gmail.com ☑ College graduate  Others, pls. specify ___________________

 Fax::  Post graduate

Separated

Others:  Others: ___________

Work Experience
Length of
Name of Company/Employer Position Inclusive Dates Nature of Job
Service
MUNICIPALITY OF CAINTA INSPECTOR (SCAFFOLDING WORKS) 2015 2022 INSPECTOR 7

(For more information, please use separate sheet)

Education and Training

Title Course Inclusive Dates Institution
UNIVERSITY OF SANTO
BACHELOR OF SCIENCE ARCHITECTURE 2010 2015 TOMAS

(For more information, please use separate sheet)

Certification Record
Date of
Title Qualification Level Industry Sector Certificate Number Certification Expiration Date
SCAFFOLDING WORKS NCII CONSTRUCTION 20045802006085 3/12/2020 3/11/2025

(For more information, , please use separate sheet)

Endorsed
by: Name of Association Date of
(for __________________________________________ endorsem
industry NAME & SIGNATURE / POSITION/ DESIGNATION ent
Specimen Signatures:

Right
Thumb
1. _________________________________ 2. __________________________________________ mark