TESDA-OP-CO-05-F26
Rev. 00 – 03/08/17
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY
Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan
 APPLICATION FORM
EAW 2
REFERENCE NUMBER :
Qual – alpha
code
3
1
YY
3
Region
1
6
1
Province
0
1
0
0
Number Series
Assigned to AC
0
Number Series
UNIQUE
PICTURE
LEARNERS IDENTIFIER (ULI):
-
-
-
-
0
0
1
colored,
to be filled – out by the Processing Officer
passport size,
white
background
APRIL 25, 2023
Applicant’s Signature
Date of Application
Name of School/Training Center/Company:
Address:
Title of Assessment applied for: SHIELDED METAL ARC WELDING NC III
Full Qualification


COC

Renewal
1. Client Type

TVET Graduating Student
TVET graduate

Industry worker
K-12


OFW
2. Profile
2.1. Name:
 SURNAME
G
E
R
A
I
L
 FIRSTNAME

R
O
N
E
L


B
A
L
A
N
MIDDLE
NAME
2.2.
Mailing
Address:
L
O
MIDDLE INITIAL
G
TALOLORA
109
Number, Street
II
Barangay
PALAPAG
District
N. SAMAR
City
NAME EXTENSION
(e.g. Jr., Sr.)
B.
Province
VIII
6421
Region
Zip Code
2.3. Mother’s Name CAROLINA B. GERAILLO 2.4. Father’s Name ROLANDO R. GERAILLO
2.5. Sex
2.6. Civil Status 2.7. Contact Number(s)
2.8. Highest Educational
Attainment
2.9. Employment
Status
 Male

Single
Tel: N/A
 Elementary Graduate  Casual
 Female

Married
Mobile: 09126017912
 High School Graduate  Job Order
 Widow/er
E-mail:
ronelgeraillo@gmail.com
 TVET Graduate
 Probationary
 Separated
Fax: N/A
 College Level
 Permanent
Others:
 College Graduate
 Self - Employed
 Others: ____________  OFW
2.10
Birth date (mm/dd/yy): M 1
3. Work Experience
M 2 D 1
D 2 Y 9
Y 2
2.11
Birth
place:
PALAPAG N. SAMAR
2.12 Age: 30
(National Qualification-related)
3.1.
3.2.
3.3.
Name of Company
Position
Inclusive Dates
Industrial Arts Department - SMAW
Welder Instructor
06/22/2018 PRESENT
N/A
N/A
N/A
N/A
(For more information, please use separate sheet)
N/A
N/A
3.4.
Monthly
Salary
N/A
N/A
3.5.
Status of
Appointment
15, 300
REGULAR
N/A
N/A
N/A
N/A
3.6
No. of Yrs.
Working Exp.
5
N/A
N/A
4. Other Training/Seminars Attended (National Qualification-related)
4.1.
Title
4.2.
Venue
4.3.
Inclusive Dates
4.4
No. of Hours
4.5
Conducted By
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
(For more information, please use separate sheet)
5. Licensure Examination(s) Passed
5.1.
Title
5.2.
5.3.
Year Taken Examination Venue
5.4.
Rating
BOARD LICENSURE EXAMINATION
FOR PROFESSIONAL TEACHER
2016
NORTHERN SAMAR
N/A
N/A
N/A
5.5.
Remarks
5.6.
Expiry Date
CATARMAN
8I.80
N/A
PASSED
N/A
12/12/2025
N/A
(For more information, please use separate sheet)
6. Competency Assessment(s) Passed
6.1.
6.2.
6.3
Qualification
Level
Industry Sector
Title
BREAD AND PASTRY PRODUCTION
DOMRAC
N/A
NCII
NCII
N/A
6.4.
6.5.
Certificate Number
Date of Issuance
TOURISM
HVAC
N/A
22130902000888
19130402011478
N/A
6.6.
Expiration Date
03/16/2022
08/15/2019
N/A
03/15/2027
08/14/2024
N/A
(For more information, , please use separate sheet)
ADMISSION SLIP
REFERENCE
NUMBER :
EAW 2
3
1
3
1
Name of Applicant: RONEL B. GERAILLO
6
1
0
0
0
0
PICTURE
Tel. / Mobile Number: 09126017912
 Regular
Assessment Applied for:
1
SHIELDED METAL ARC
 Mandatory
 CACW
(Passport
size)
Official Receipt Number:
WELDING NC III
Date Issued:
To be accomplished by the Processing Officer
Name of Assessment Center: TESDA Regional Training Center – NCR
Bldg. 14, Gate 2 TESDA Complex, East Service Road, SLEX, Taguig City | assessment.rtcncr@tesda.gov.ph
 Globe - 09171273635 | Smart - 0968-852-8204
Remarks:
Check submitted requirements:

Accomplished Self-Assessment Guide


Three (3) pieces colored passport size pictures
E-TESDA Certificate: Practicing COVID-19
Preventive Measures in the Workplace
Consent Form

Assessment Date:
Date:


Bring own Personal Protective Equipment
Others. Pls. specify:
Original and Photocopy of required
documents
Packed snacks / lunch
Assessment Time:
7:30 AM
ARYAN R. BECIRIL
RONEL B. GERAILLO
Printed Name & Signature of Processing Officer
Printed Name & Signature of Applicant
Date:
Note: Please bring this Admission Slip on your assessment date.