Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
SCHOOLS DIVISION OFFICE
DAGUPAN CITY

EQUIVALENTS RECORD FORM

Name: __________________________________________ Date of Birth: _______________ Sex: ___________

(Surname) (Given) (Middle Name)

Employee No: ______________________________ Authorized Position Title: __________________________

Item No.: __________________________________ Authorized Salary: ________________________________
I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY
Degree or Highest Degree Attained Name of Institution School Year Civil Service Examination Date

I. SERVICE RECORDS: ATTACHED DULY CERTIFIED SERVICE RECORDS

II. EQUIVALENT UNITS
A. Total no. of years teaching (public only) _____________ Equivalent: _____________
B. Degree to degree equivalent (present degrees) _____________ Equivalent: _____________
C. AREAS OF EQUIVALENT SCHOOL YEAR NO. OF UNITS DESCRIPTION
1. Professional Study
2. Teaching Experience
a. Public School
b. Private School
3. Administrative Supervisory Experience
a. Public School
b. Private School
4. Others (seminar, workshop, training, etc.)

Latest Performance Rating: _______________

___________________________ ___________________________
Teacher’s Signature School Principal

NOTE: Teachers do not write below

III. DIVISION ACTION
Salary Scheduled
Classification Date Processed Grade Assignment Remarks
Grade Salary

CERTIFIED CORRECT: RECOMMENDING APPROVAL:

MYREL ANGELICA N. LOPEZ LORNA G. BUGAYONG, Ph. D., CESO VI

Administrative Officer V Schools Division Superintendent

IV. DEPED REGIONAL OFFICE ACTION

Classification: _________________________________ Salary Grade: ______________________________

Date Approved/Processed _______________________ Post Audited Salary Grade: ___________________

Reviewed: Approved:

ROSARIO D. ESTIMO JESSIE L. AMIN, CESO V

Teacher Credentials Evaluator II Officer-In-Charge
Office of the Assistant Regional Director
* THE APPROVAL OF THE EQUIVALENTS RECORD FORM IS AUTOMATICALLY CANCELLED IF HIS/HER RECORDS
UPON WHICH THE APPROVAL IS BASED ARE LATER FOUND FICTITIOUS OR FRAUDULENT.