Republika Ng Pilipinas

KAGAWARAN NG EDUKASYON
Rehiyon XI
SANGAY NG LUNGSOD NG DAVAO
Lungsod Ng Davao

EQUIVALENT RECORD FORM

Name: _________________________________________________________ Date of Birth: ______________________ Sex: ____________

(Surname) (First Name) (Middle Name)
Employee Number: ______________________________ Authorized Position Title: ______________________________
Item No.: ______________________________________ Authorized Annual Salary: _____________________________
Station Code No.: _______________________________

I. Education Attainment and Civil Service Eligibility: :

Units, Degrees of Highest Year CS / Board
Name of Institution Rating Date
Grade Attained Received Examination

II. Service Record: Attached Duly Certified Service Record

III. Equivalent Units:
A. Total No. of years teaching (Public only): _______________________ 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 Experiences
a. Public School
b. Private School
c. Other (Seminar Workshop, etc.) Please see separate sheets

LATEST PERFORMANCE RATING: ___________________________________

______________________________________
Teacher’s Signature
IV. School / District Action (To be filled out by the District Office or Secondary School):

Classification Date Processed Range Assignment Salary Grade Salary Schedule Remarks

Recommending Approval: Verified:

_____________________________________ ____________________________________
PSDS / School Head HRMO

V. DIVISION OFFICE ACTION:

Classification: _________________________ Range: ________________________ Post Audited Range: _________________________
POST AUDIT OF TEACHING POSITION
CLASS TITLE : ____________________
SALARY GRADE : ____________________
SUBJECT TO AVAILABILITY OF AN ITEM
BY THE AUTHORITY OF THE SECRETARY OF EDUCATION

ROMEL L. TAMBIS MARIA INES C. ASUNCION, CESO V

Administrative Officer IV / Evaluator Schools Division Superintendent
 OATH

I hereby certify that I have been actually enrolled in the schools listed in the
accompanying transcript of records and that I have actually earned the units indicated
therein.

As required, the Commission on Higher Education has been furnished with authentic
copies of the sworn statement and its enclosure.

_____________________________
Signature over printed name

SUBCRIBED AND SWORN to before me this _______________ day of

________________ 2019 affiant exhibiting his/her Community Tax Certificate No.
________________ issued at Davao City on _________________.

___________________________________
Signature of Person Administering the Oath

Doc. No. : ______________

Page No. : ______________
Book No. : ______________
Series No.: _____________