EF Assessment Tool (page 1 of 2)

Note: Fields marked with an asterisk (*) are required fields. If not applicable, put N/A on the space/s provided.

INTRODUCTION CONSENT & CONFIDENTIALITY CLAUSE

Good morning/afternoon, my name is (MPDO’s
FULL NAME). We are conducting an assessment
visit which aims to collect your basic information
and track the status of your employment as a result of
being a SLP beneficiary. May I have some of your
time for an interview?
All information contained herein shall be maintained in a secured database and shall be processed manually or electronically to track the status of the em-
ployment for further assessment in identifying appropriate assistance that can be given by SLP, to mainstream to other stakeholders/ partners, or validate to
other databases of social protection/welfare programs. Further, any controlled disclosure or transfer of any personal information or sensitive personal infor-
mation to development partners, evaluation firms, academe, and other stakeholders shall be in accordance with the Data Privacy Policy and Sharing Protocol
of the program and provisions under the DPA of 2012. You have the right to object to the processing of your personal data, the right to access your personal
data that we will process, and the right to have your personal data corrected.

I agree to participate in this assessment visit and allow _______________________________________

my answers to be used as indicated above.
Signature over Printed Name

A. EF PARTICIPANT INFORMATION Time Started: ______

Time Ended: ______
A.1 Location of the Employment *

______________________________________________________________________________________________________________________
House & Lot No. Street Barangay City/Municipality Province Region

A.2 Modality/ies Provided (please check /specify) & Date Provided (mm/dd/yyyy)*

PEAF/EAF Date Provided:_______________ ST-EF Date Provided:_______________ Others, please specify: _________________________ Date Provided: _______________

A.3 Name of SLP Participant* A.4 SLP Participant Unique Code (if applicable)

________________________________________________________________________________
First Name Middle Name Last Name Ext.
A.5 Location of the Participant*

______________________________________________________________________________________________________________________
House & Lot No. Street Barangay City/Municipality Province Region

A.6 Designation within SLPA (if applicable) A.7 Sex* A.8 Type of Participant* A.9 Contact Number
Male Female Pantawid Listahanan Poor SLP Means Test Poor

A.10 Name of SLP Association (if applicable)

B. EF ASSESSMENT Date Assessed (mm/dd/yyyy):_____________ No. of Visits Made: ____

Instructions: Write the appropriate code of EF attributes in the space provided below that best describe the employment of the participant. The codes of the said attributes are enumerated at the next page of this
form. If not applicable, write N/A and provide explanation in the remarks section. Any additional important notes may be written in the remarks section.

EF Attributes Original Employment Additional Employment 1 Additional Employment 2

Code

B.1 Matched Skills

and Qualifications
to the Job Remarks

Code

B.2 Financial Man-

agement of Earn-
ings from the Em- Remarks
ployment

Code

B.3 Assets Ac-

quired/Received
Remarks

Code

Remarks

B.4 Clear Path for

Career Job
Growth and Devel-
opment Code

Remarks
EF Assessment Tool (page 2 of 2)
Note: Fields marked with an asterisk (*) are required fields. If not applicable, put N/A on the space/s provided.

CODE FOR EF ATTRIBUTES

B.1 Matched Skills and Qualifications to the B.2 Financial Management of Earnings from the B.4 Clear Path for Career Job Growth and
B.3 Assets Acquired/Received
Job Employment Development

B.1.A The participants’ skills, qualifications, interest, B.2.A The participant is able to save from the wage he/she B.3.A The participant has acquired new physical, natural, or B.4.A The participant has provided/attended a training/
and abilities match the acquired job. earned and is used for other income generating activities. financial assets from the savings of his/her wage and is being seminar/workshop for skills improvement.
used by the household.
B.1.B The participants’ skills, qualifications, interest, B.2.B The participant is able to save from the wage he/she B.4.B The participant has not attended any training/
and abilities do not match the acquired job. earned but was not used for other income generating activi- B.3.B The participant is not able to use his/her savings to seminar/workshop for skills improvement.
ties. acquire new physical, natural, or financial assets

B.2.C The participant is not able to save from the wage he/
she earned.
B.4.C The participant has a clear goal and vision for
career/job plans.

B.4.D The participant has no clear goal and vision for

career/job plans.

C. ACTIONS TO BE TAKEN

EMPLOYMENT STATUS OF
EF (Write if Original Employment ISSUES/CONCERNS* RECOMMENDATIONS* RECOMMENDATIONS*
ATTRIBUTES Additional Employment 1 or
(please check)
Additional Employment 2)

Completed

On-going

Still for
discussion with
Participant

Completed

On-going

Still for
discussion with
Participant

Completed

On-going

Still for
discussion with
Participant

Completed

On-going

Still for
discussion with
Participant

Completed

On-going

Still for
discussion with
Participant

Completed

On-going

Still for
discussion with
Participant

D. FORM CERTIFICATION

Accomplished by: Reviewed and Approved by:

__________________________________________ _________________________________________________ ________________

Signature over Printed Name of Monitoring PDO Signature over Printed Name of Provincial Coordinator Date