Republic of the Philippines

DEPARTMENT OF EDUCATION
REGION III – CENTRAL LUZON
Schools Division of BULACAN
School/District:________________________

EQUIVALENT RECORD FORM

(Submit in Four Copies)

Name: ________________________________ Date of Birth: _____________________ Gender: _______________

(Surname) (Given) (M.I.)

Employee No.:_______________________ Authorized Position Title: ____________________

Item No.: ___________________________ SG: _______ Authorized Annual Salary: _____________________

I. Educational Attainment

Masters Degree Completed/ Name of School Year Completed Equivalent

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

II. Years of Teaching Experience: ___________________________________

Public : _______________________________________________
Private : _______________________________________________

III. Trainings Attended

Title Inclusive Dates Number of Hours Sponsoring Agency

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

V. Latest Performance Rating: _________________________________

___________________________
(Teacher’s Signature)

VI. School Divisions Action (For School Division Evaluator Only)

Classification Date Range Assignment Salary Grade Salary REMARKS

Processed Schedule

Certified Correct: Recommending Approval:

VICTORIA O. MADRIGAL ZENIA G. MOSTOLES, EdD, CESO V

AO IV-Personnel Schools Division Superintendent
Schools Division Evaluator

VII. DepEd Regional Office Action__________________________________________________________________________

Classification: __________________________ Post Audited Assignment: ______________________________
Date Processed: ________________________ Salary Grade: ________________________________________
Salary Schedule: _____________________________________
Remarks: ___________________________________________

Approved:
_______________________________
Evaluator