Republic of the Philippines

Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE OF QUEZON CITY

EQUIVALENT RECORD FORM

Name: _________________________________________________________________________ Date of Birth: ______________ Sex: ________

(Surname) (Given Name) (Middle Name)
Employee Number: ____________________________________ Authorized Position Title: _____________________________
Item Number: __________________________________________ Authorized Salary PHP: _____________________________

I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY:

Titles, Degrees of Highest Name of Year Civil Service Rating Date
Grade Attained Institution Received Examination

II. SERVICE RECORDS: ATTACHED DULY CERTIFIED SERVICE RECORD

III. EQUIVALENT UNITS:
A. Total No. of Years in Teaching (Public Only) Equivalent
B. Degree to Degree Equivalent Present Degree Equivalent
School Year No. of Units Description
C. Areas of Equivalent
1. Professional Study
2. Teaching Experience
a. Public School
b. Private School
3. Adm./Supervisory Experience
a. Public School
b. Private School
4. Others (seminars, workshops, etc.)
T O T A L: _______________
____________________________________________
(Teacher’s Signature)
LATEST EFFICIENCY RATING (Numerical): ______________
(Adjectival): ______________ School: ______________________________________________________________

Certified correct: SILVERIO O. ESTORCO

Principal IV

Note: To the teacher, do not write below.

IV. Division Action Range Salary Scheduled
Date Processed Remarks
Classification Assignment Range Salary

Recommending Approval: Verified Correct:

JENILYN ROSE B. CORPUZ, CESO VI MARIE JEANNE CARMELLI R. DESIDERIO

Schools Division Superintendent Administrative Officer IV/HRMO II

V. DepEd and Regional Office Action

Classification___________________________________________ Range _______________________________
Post-Audited Range ____________________

Date Approved/Processed ________________________________ (For Future Reference)

______________________________________________________ __________________________________________________
(Regional Director) (Evaluator)

VI. DepEd Proper Action

___________________________________________________________________________________________________________________________
Nueva Ecija St. Bago Bantay Quezon City (02) 89960640

teaching,personnelunit@depedqc.ph