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REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF EDUCATION
Caraga Administrative Region

Equivalent Record Form

Name: _____________________________ Date of Birth: _____ Sex: ______


Employee No. :______________________ Authorized Position Title: ______________
Item No. : __________________________ Actual Salary: ________________________

I. Educational attainment and Civil Service Eligibility


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

II. Service Records ( attach duly certified Service Records)

III. Equivalent Units


A. Total No. of Years of Teaching: _______________________
B. Degree to Degree Equivalent: (Present Degree) _____________
C. Areas of Equivalent:

Areas School Year No. of Units


1. Professional Study
2. Teaching Experience
a.) Public School
b.) Private School
3. Administrative/Supervisory Experience
a.) Public School
b.) Private School
4. Others (Seminars, Workshop, etc.)
TOTAL

Latest Efficiency Rating: _________________ __________________________


Teacher's Signature
CERTIFIED CORRECT:

______________________________________ __________________________
School Principal Administrative Office

Approved:

______________________________________ DR. IMELDA N. SABO


HRMO OIC - Schools Division Su
_______________
____________________
______________

Date

Units Description

______________________
Signature
______________________
ive Officer VI

N. SABORNIDO
vision Superintendent