Republic of the Philippines

Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO ORIENTAL

EQUIVALENT RECORD FORM

Municipality : _____________________________ School: ____________________________ District : __________________
Name: _________________________________________________ Date of Birth: ______________________ Sex: ____________
(Surname) (Given Name) (M.I.)
Employee No. _____________ Item Number: __________________________ Authorized Position Title: _________________
Page Number : __________________________ Authorized Salary: __________________
I. EDUCATIONAL ATTAINMENT AND ELIGIBILITY:
Title, Degree or Highest Grade
Attained Name of Institution Year Received Eligibility Rating Date

II. SERVICE RECORD: Attached duly certified service record

III. EQUIVALENT UNITS:
A. Total No. of Years Teaching (public only) _______________ years. Equivalent : ___________________________
B. Degree to Degree Equivalent (present degree) __________ M.A. Units Equivalent : ___________________________
C. Areas of Equivalent School Year No. of Units/Years Description
1. Professional Study __________________ _________________ _____________________________________
_____________________________________
__________________ _________________ _____________________________________
_____________________________________
TOTAL _________________
2. Teaching Experience
a. Public School __________________ _________________
b. Private School __________________ _________________
Latest Efficiency Rating: ________________________
_________________________________
Teacher's Signature
APPROVAL RECOMMENDED: ________________________________

IV. DIVISION ACTION:

CLASSIFICATION Date Processed Range Assignment Salary Grade Scheduled Salary Remarks

CERTIFIED CORRECT: EMMA O. RABUYA MARIA GENEVIEVE T. FRANCISQUETE, ED.D

Administrative Officer V Assistant Schools Division Superintendent
Evaluator

APPROVED:

REYNALDO B. MELLORIDA, CESO V

Schools Division Superintendent

O A T H
I hereby certify under oath that I have actually enrolled in the school(s) listed in the accompanying Transcript of Records
and that I have earned the units indicated therein.
_________________________________________
SIGNATURE OVER PRINTED NAME

SUBSCRIBDE AND SWORN TO BEFORE ME this ________________________, affiant exhibiting his/her Community Tax
Certificate No./__________________ issued at ____________________ on ____________________________.

Doc. No. _________

Page No. _________ ___________________________________
Book No. _________ Notary Public
Series of: ___2020__

“GOVERNANCE THROUGH EXCELLENCE WITH INTEGRITY ANYTIME, ANYWHERE”

Address: Government Center, Dahican, Mati City, Davao Oriental ISO 9001:2015
Telephone Number: (087) 388-3372 CERTIFIED