Republic of the Philippines

Department of Education
Region IV-A CALABARZON
DIVISION OF QUEZON
Talipan, Pagbilao, Quezon

EQUIVALENT RECORD FORM

(Submit to DepEd in five copies)

Name: ________________ __________________________ Date of Birth: ________________________ Sex: ________

(Surname) (Given Name) (Middle)
School: ________________________________________ Address: ______________________________________
Employee No. ________________________________ Authorized Position Title: ________________________
Item No. ______________ P. D. No. _______________ Authorized Salary: __________

I. EDUCATIONAL ATTAINMENT & CIVIL SERVICE ELIGIBILITY

Title, Degree or Highest Grade Year Civil Service/
Name of Institution Rating Date
Attained Received PRC Exam
Master of Arts in Education-Educ. Management Northern Quezon College, Inc. 2014 LET 81 9/2012
CS Prof. Level 81 4/2010
CS Sub.Pro Level 81 10/2003
II. SERVICE RECORD: (Attached duly certified Service Record)
III. EQUIVALENT UNITS:
A. Total No. of Years Teaching (Public only) ______________ Equivalent __________
B. Degree to Degree Equivalent (Present Degree) ___________ Equivalent __________

C. Areas of Equivalent:

School Year No. of Units Description

1. Professional Study 2012-2014 Graduate MAEd Educ. Management
2. Teaching Experience
a. Public School 2013-present Classroom Teacher
b. Private School 2012-present College Instructor(part-time)
3. Adm. Supervisory Experience
a. Public School
b. Private School
4. Others (Seminars, Workshop, etc.)
LATEST EFFICIENCY RATING: ____________

Teachers Signature

NOTE: Teacher Do not write below

IV. DIVISION ACTION:

Grade Salary Scheduled
Classification Date Processed Remarks
Assignment Grade Salary

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

MERTHEL M. EVARDOME CESO VI MELVA M. RAMA

Schools Division Superintendent Administrative Officer II

V. DepEd REGIONAL OFFICE ACTION:

Classification: __________________________ Range: __________________________

Date Approved/ Processed: _______________________ Post audit at range ________________
(for future reference)

VI. DepEd PROPER ACTION