Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
Division of Lipa City

EQUIVALENT RECORD FORM

Name: ___________________________________________ Date of Birth:__________________ Sex: ___________________
Surname Given name Middle
School: ___________________________________ District:
______________________
Address:___________________________________
Employee No.: ______________________________ Authorized Position/Title:
_________________________________________________
Item No: ___________________________________ Authorized Salary:___________________________________
I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY

Title, Degree or Highest Grade Year Civil Service PRC

Name of Institution Received Rating Date
Attained Exam

II. SERVICE RECORD: (Attached duly certified Latest Service Record)

III. EQUIVALENT UNITS:
A. Total No. of Years Teaching: (Public Only)______________________________ Equivalent: ___________________________________
B. Degree to Degree Equivalent: (Present Degree) ____________________________ Equivalent: ___________________________________

C. Areas of Equivalent: School Year No. of Units Description

1. Professional Study
2. Teaching Expeience
a. Public School
b. Private School
3. Adm. Supervisory Experience
a. Public School
b. Private School
4. Others (Seminars, Workshop, etc.,
LATEST EFFICIENCY RATING: _____________________________________
________________________________
Teacher's Signature
Signature over printed name of the school head

NOTE: Teacher (Do Not Write Below)

IV. DIVISION ACTION
Classification Date Processed Grade Assignment Salary Grade Scheduled Salary Remarks

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

LEAH MARIE MONICA K. LUMBRES

SUSAN DL. ORIBIANA, CESO VI Administrative Officer V
OIC-Schools Division Superintendent

V. DepEd REGIONAL OFFICE ACTION

Classification:_______________________________________________ Range:_____________________________________________
Date Approved/Processed:____________________________________ Post Audit at ange:__________________________________
(For future reference)
_______