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Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
Division of Lucena City

EQUIVALENTS RECORD FORM

Name: Date of Birth: Sex:


Surname Given name Middle
School: LUCENA DALAHICAN NHS District: SOUTH Address:
Employee No.: Authorized Position/Title:
Item No: Authorized Salary:
I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY
Title, Degree or Highest Grade Year Civil Service PRC
Name of Institution Rating Date
Attained Received Exam

II. SERVICE RECORD: (Attached duly certified Latest Service Record)


III. EQUIVALENT UNITS: _________________________________________
A. Total No. of Years Teaching: (Public Only) 6 years Equivalent:______________________________
B. Degree to Degree Equivalent: (Present Degree) ___________________________Equivalent: ___________________________________

C. Areas of Equivalent: School Year No. of Units Description


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, Workshop, etc.,)

LATEST EFFICIENCY RATING: ______


________________________________
Teacher's Signature
NOTE: Teacher (Do Not Write Below)
IV. DIVISION ACTION
Classification Date Processed Grade Assignment Salary Grade Scheduled Salary Remarks

RECOMMENDING APPROVAL:

DR. HERMOGENES M. PANGANIBAN BENJIE C. RIVERA


Schools Division Superintendent Administrative Officer

V. DepEd REGIONAL OFFICE ACTION

DEPARTMENT OF EDUCATION
REGION IV-A CALABARZON
POST AUDIT OF TEACHING POSITION
CLASS TITLE: _______________________
SALARY GRADE:____________________

By Authority Of The Secretary of Education:


Evaluator

Date Approved/Processed:________________________________

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