Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION III-CENTRAL LUZON
Schools Division of
_
EQUIVALENT RECORD FORM
(Submit in Five Copies)

Name: Date of Birth: ,Gender:

(Surname) (Given) (M.I.)
Employee No.: __________ Authorized Position Title: ___________________
Item No. :______________ SG:_____ Authorized Annual Salary: ___________________

I. Educational Attainment

Name of School Year Completed Equivalent

Master’s Degree Completed/
(write in full with Units Earned
specialization) (if not completed)

II. Years of Teaching Experience: _____________

Private :________________________
Public :________________________

III. Trainings Attended

Title Sponsoring Agency

Inclusive Number of
Dates Hours

IV. For Head Teacher Positions and Other Related Teaching Positions
Years of Experience in Present Position:

V. Latest Performance Rating: ______

(Teacher’s Signature)
VI. Schools Division Action (For Schools Division Evaluator Only)
Classification Salary Grade REMARKS
Date Range Salary
Processed Assignment Schedule

Certified Correct: Recommending Approval:

MARIA NICHOLETTE C. ROJO ROMEO M. ALIP, Ph. D., CESO V

AO IV-Personnel Schools Division Superintendent
Schools Division Evaluator

V. DepEd Regional Office Action

Classification: Post Audited Assignment:
Date Processed: Salary Grade :
Salary Schedule :
Remarks :

Approved:

______________________________________
Evaluator