Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Cagayan
District/School ___________________________________

EQUIVALENT RECORD FORM

Name:____________________________________ Date of Birth: ________________ Sex: ___________

(Surname) (Given Name) (M.I.)
Employee No: __0002523___________________ Authorized Position Title: ______________________
Item No: ______________________ P.D. No.:___________________ Authorized Salary:____________

I. Educational Attainment and Civil Service Eligibility:

Title Degree or
Name of Institution Year Civil Service Rating Date
Highest Grade
Received Examination
Attainment

II. Service Records: ATTACHED DULY CERTIFIED SERVICE RECORD

III. Equivalent Units:
A. Total No. of Years: (Public Only) __________________________ Equivalent: ____________
B. Degree to Degree Equivalent: (Present Degree)________________ Equivalent: ____________
C. Areas Equivalent: __________________
School Year No. of Units Description
1. Professional Study
2. Teaching Experience
a. Public School
b. Private School
3. Adm. Supervisor Exp.
a. Public School
b. Private School
4. Other (Seminars, Workshops,
etc.)
TOTAL
IV. LATEST EFFICIENCY RATINGS: _______________________
Certified Correct:
____________________________ __________________________
District Supervisor/Principal Teacher’s Signature
CLASSIFICATION DATE RANGE SALARY SCHEDULED REMARKS
ASSIGNMENT RANGE SALARY

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

______________________________ __________________________
OIC, Asst. Schools Division Superintendent Division Processing Officer
V. DepEd Regional Office Action
Classification __________________________ Range ___________________________
Date Approved Processed_______________ Post Audited at Range ______________
(of future reference)

Approved:

______________________________ ________________________
Schools Division Superintendent Administrative Officer V
OIC-Office of the Assistant Regional Director