Technical Education and Skills Development Authority

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

NMIS FORM –01A
( For TPIS )

TRAINERS / ASSESSOR PROFILE FORM

In accomplishing this form, entries in

Italicized letters are optional while the rest
are mandatory or required information.
ID PICTURE
(Passport size)

RIGHT THUMBMARK

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:
Last First Middle

2.2.
Mailing
Address:
Number, Street Barangay District

City Province Region Zip Code P.O. Box No.

2.3. Gender 2.4. Civil Status 2.5. Contact Number(s) 2.6. Employment Type 2.7. Employment Status
 Male  Single Telephone:  Employed  Casual  Probationary
 Female  Married Cellular:  Self-employed  Contractual  Regular
 Window/er Pager:  Unemployed  Job Order  Permanent
 Separated e-mail:  Undefined  Temporary
Fax:  If Student
Others:  Trainee/OJT

3. Personal Information
3.1. Birthdate: 3.7. Height: 3.12. SSS No.:
3.2. Birth Place: 3.8. Weight: 3.13. GSIS No.:
3.3. Citizenship: 3.9. Eye Color: 3.14. TIN No.:
3.4. Religion: 3.10. Hair Color:
3.5. Ethnicity: 3.11. Blood Type: 3.15. Distinguishing Marks:
3.6. Disability:

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

5. WORKING EXPERIENCE ( For Trainers, mandatory field 5.5)

5.1. 5.2 5.3 5.4 5.5 5.6
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)

6. Training/Seminars Attended
6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9
Inclusive *Certificate # of Training
Title Venue Category Conducted By Proficiency
Dates Received Hours Base

(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

7. Licenses/Examinations Passed
7.1. 7.2 7.3 7.4 7.5 7.6
Title Year Taken Examination Venue Rating Remarks Expiry Date

(For more information, indicate on a separate sheet)

8. Skills Specialization
8.1 8.2 8.3 8.4 8.5 8.6
Industry Sector Trade Area Occupation Classification Level Competency Specialization Description

(For more information, indicate on a separate sheet)

9. Family Background
9.1. Spouse’s Name: 9.3 Occupation:
9.2. Educational Attainment: 9.4 Ave. Monthly Income:
9.5. Father’s Name: 9.7. Occupation:
9.6. Educational Attainment: 9.8. Ave. Monthly Income:
9.9. Mother’s Name: 9.11. Occupation:
9.10. Educational Attainment: 9.12. Ave. Monthly Income:
9.13. Name of Guardian: 9.15. Occupation:
9.14. Educational Attainment 9.16. Ave. Monthly Income:
9.17. Dependents 9.18. Age Dependents Age

(For more information, indicate on a separate sheet)