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 Attainme nt

Masters Degree Completed/ Name of School Year Completed Equivalent

(write in full with Units Earned
specialization) (if not completed)

II. Years of Teaching Experience:

Private :
Public :

III. Trainings Attended

Title Inclusive Number of Sponsoring Agency
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 Date Range Salary Grade Salary REMARKS
Processed Assignment Schedule

Certified Correct: Recommending Approval:

JB B. MANALANG LEONARDO D. ZAPANTA, Ed. D., CESO VI

AO V-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