Republic of the Philippines

Department of Education
Region I
DIVISION OF CITY SCHOOLS
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

II.
Service Record
ATTACHED DULY CERTIFIED SERVICE RECORD
NOTE: Teachers do no write below
III.
Equivalent Units
A. Total no. of years teaching (public
_____________
only)
B. Degree to degree equivalent (present _____________
degrees)
C. AREAS OF EQUIVALENT
SCHOOL
NO. OF
DESCRIPTION
YEAR
UNITS
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: _______________
___________________________
Teachers Signature
IV.

___________________________
School Principal

Division Action
Classification

Date
Processed

Grade Assignment

CERTIFIED CORRECT:
MYREL ANGELICA N. LOPEZ
Administrative Officer V

V.

Salary
Grade

Remarks

RECOMMENDING APPROVAL:
FROSERFINA J. BRAVO
Officer-In-Charge
Office of the Schools Division
Superintendent

DepED Regional Office Action *

Classification: _________________________________ Salary Grade:

______________________________

Scheduled
Salary

Date Approved/Processed _______________________

___________________
Reviewed:

Post Audited Salary Grade:

Approved:
ROSARIO D. ESTIMO
Evaluator

* 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.