SOMALI REGIONAL STATE
Center of Competency
Somali, Ethiopia 3x4
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OUTCOME BASED ASSESSMENT APPLICATION FORM Photo
Registration No._________________
This form, when completed, must be submitted together with three (3) photos 3 x 4 size to the Center of Competence.
____________________________________ _________________________________________
(First Name) (Father’s Name) (Grand Father’s Name)
Birth Date Month: ________________ Day: __________ Year: __________Age: _____________
Gender/Sex: Male Female Citizenship: _______________________________________
Address: House No. ____ Kebele ________________ Woreda/ City _______________________
Phone: House_________________ Office __________________ Mobile ___________________
Education Background (Highest Attainment):
Elementary Graduate Secondary/HS Undergraduate Secondary/HS graduate
Diploma Undergraduate Diploma Graduate/Certificate Degree Undergraduate
Degree Graduate 2nd Degree Undergraduate 2nd Degree Graduate
Name of Institution: ________________________Degree/Diploma: ________________________
Government Private
Employment Background (Job Category):
Local Based Worker Foreign Based Worker Self-Employed
TVET Teacher New TVET Graduate Not Employed
Name of present employer (Company/Office/College/University): __________________________
Government Private
I hereby submit my application for assessment of my competencies as a_____________________
(Name of occupation)
I assure that I have gained practical experience in the occupation for _________ months/years.
I am able to read and write and communicate in the following language:
English, other, which are___________________, __________________, & __________________
Along with this application I shall pay an application fee of __________ Birr. If any special
arrangements (related to health and physical disability), you
______________________________I wish to be assessed for the occupation mentioned above:
I will be assessed only knowledge only practical both
________________________________ ________________
Signature of Applicant/Candidate Date
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SEAL
SOMALI REGIONAL STATE
Center of Competence 3x4
OUTCOME BASED ASSESSMENT ADMISSION SLIP
Photo
Registration No._________________ Date Registered: __________________
Name: _________________________________________________________
Address: _______________________________________________________
Competency Assessment applied for: ________________________________________________
(Occupational title and Level)
Type of Test Date Venue Application Fee(Receipt No.)
Knowledge
Practical
___________________________________ ____________________
Name & Signature CoC Processor Date
