Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III – Central Luzon
SCHOOLS DIVISION OF SAN JOSE DEL MONTE CITY
City of San Jose del Monte 3023

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/

(Write in full with Units Earned Name of School Year Completed Equivalent
specialization)
(If not completed)

II. Years of Teaching Experience: _________________

Private : _______________________
Public : _______________________
III. Trainings Attended
Inclusive Number of

Title Dates Hours Sponsoring Agency

IV. For Head Teacher Position and other Related Teaching positions
Year of Experience in Present Position: _______________________
V. Latest Performance Rating: _______________
__________________________________________
Teacher’s Signature
VI. School Division Action ( For Schools Division Evaluator Only )
Classification Date Processed Range Assignment Salary Grade Salary Schedule REMARKS

Certified Correct: Recommending Approval:

MA. THERESA M. ROXAS MERLINA P. CRUZ PhD, CESO V

AO IV / HRMO Schools Division Superintendent
Schools Division Evaluator
VI. DepEd Regional Office Action_______________________________________________________________________________
Classification: ___________________________________ Post Affiliated Assignment: __________________
Date Processed : _______________________ Salary Grade : _______________
Salary Schedule : ______________
Remarks: _______________

Approved :

___________________________________ ____________________________________
Evaluator