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EQUIVALENT RECORD FORM

Name: _____________________________________________ Date of Birth: _____________Sex:______


(Surname) (Given Name) (Middle Name)
Employee No.: __________________________________ Authorized Position Title: _________________
Item No.: _______________________________ Authorized Salary Php: ___________________

I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY:


Titles, Degree or Highest Name of Year Civil Service
Rating Date
Grade Attained Institution Received Exam

II. Service Records: ATTACHED DULY CERTIFIED SERVICE RECORD


III. Equivalent Units:

A. Total No. of Years in Teaching (Public Only) Equivalent


B. Degree to Degree Equivalent Present Degree Equivalent
School Year No. of Units Description
C. Area of Equivalent
1. Professional Study
2. Teaching Experience
a. Public School
b. Private School
3. Adm./Supervisory Experience
a. Public School
b. Private School
4. Others (seminars, workshops, etc.)
Total …… ___________________________________________

___________________________
Teacher’s Signature
LATEST EFFICIENCY RATING: (Numerical): __________
(Adjectival): __________ School: Batasan Hills National High School
Certified correct:______________________ ____________________________________
DR. PROCESO T. LERA (Public Schools District Supervisor)
Principal IV School District: _______________________

NOTE: Teachers - DO NOT WRITE BELOW.


IV. Division Action Date Range Salary Scheduled
REMARKS
Classification Processed Assignment Range Salary

Recommending Approval: Verified Correct:

DR. JENILYN ROSE B. CORPUZ, CESO VI MARIA TERES A. NAMORO


Schools Division Superintendent OIC, Assistant Schools Division Superintendent
Office of the Schools Division Superintendent

V. DepEd and Regional Office Action:


Classification __________________________________ RANGE _________________________
Date Approved/Processed: Post Audited at Range ____________
(For future reference)
___________________________
(Evaluator)
______________________________
(Regional Director)
_______________________________________

VI. DepEd PROPER ACTION: