REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
DIVISION OF SARANGANI

EQUIVALENT RECORD FORM

School : __________________________________________District : _________________________________________________

Name : ___________________________________________ Date of Birth :_________________ Sex : ________________

(Surname) (Given) (Middle)

Employee No. _____________________ Authorized Position Title : ______________________

Item No. ___________________ P.D. No. ______________________ Authorized Salary : ____________________

I. Educational Attainment and Civil Service Eligibility:

Titles, Degree Name of Institution Year Received Civil Service Rating Date
Highest Attainment Examination

II. Service Records (ATTACH DULY CERTIFIED SERVICE RECORD)

III. Equivalent Units (Public only) _______________ Equivalent _____________

A. Total number of years teaching: Present Degree ____________ Equivalent _____________
B. Degree to Decree Equivalent
C. Areas of Equivalents : School Year No. of Units Description
1. Professional Study __________ ___________ ____________
2. Teaching Experiences
a. Public Schools __________ ___________ ____________
b. Private Schools __________ ___________ ____________
3. Adm. Supervisory Experience
a. Public Schools __________ ___________ ____________
b. Private Schools __________ ___________ ____________
4. Others (Seminars, Workshops, etc.) __________ ___________ ____________

TOTAL ___________ ___________

PERFORMANCE RATING ______________
(Average 3 years)

____________________________ __________________________
School Principal/School Head (Teacher's Signature)

(NOTE: Teachers Do Not Write Below)

IV. Division Action

Classification Date Processed Range Assignment Salary Range Scheduled Salary Remarks

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

CRISPIN A. SOLIVEN JR., CESE IRMA MAY G. DINASAS

Schools Division Superintendent AO V/Division Evaluator
V. DepEd Regional Office Action:

Classification ________________________ Range __________________________________

Date approved, processed: ____________ Post audited Range ________________________
(for future reference)

DR. ALLAN G. FARNAZO, CESO IV JOVEL S. HUNAS

Regional Director Evaluator

VI. DepEd PROPER ACTION

 OATH

I hereby certify that I have actually enrolled in the school or schools in the accompanying
Transcript of Records and that I have earned the units indicated therein.

As required , the Bureau of Private Schools has been furnished with authenticated copies
of the sworn statement and its enclosures.

___________________________
Signature of Teacher

Subscribed and sworn before me this ___________ day of ________________ 20 , affiant

exhibiting his/her Community Tax Certificate No. ________________________________, issued on
__________________________ at ________________________________________________.

IRMA MAY G. DINASAS

Administrative Officer V