((Inclosure to Dept. Memo. No. 140, s.

1976)

Department of Education
Region III, Division of Pampanga

EQUIVALENT RECORD FORM

Name: Date of Birth: Sex:

(Surname) (Given) (Middle name)
Employee No. Authorized Position Title:
Item No. (PSI) Blg., Authorized Salary:

I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE

TITLES, Degree or Name of Institution Year Civil Service Rating Date Taken
Highest Grade Attained School/College Received Eligibility

II. SERVICE RECORD (ATTACHED DULY CERTIFIED SERVICE RECORD)

III. EQUIVALENT UNITS

A. Total No. of years teaching Public Only Equivalent
B. Degree of Degree equivalent Present Degree Equivalent
C. Areas of equivalent
1. Professional Study School Year No. of Units Description
2. Teaching Experience
a. Public Schools
b. Private Schools
3. Adm. Supervisory Exp.
a. Public Schools
4. Other (Seminar, etc)
Total

LATEST PERFORMANCE RATING

NOTE: TEACHERS DO NOT WRITE BELOW Principal III Signature

IV. DIVISION ACTION

Classification Date processed Range assignment Salary range Scheduled salary Remarks

RECOMMENDING APPROVAL: CERTIFIED CORRECT

ROSALINDA G. LUNA JOSEPHINE F. PINEDA

Schools Division Superintendent Administrative Officer III

DECS REGIONAL OFFICE ACTION:

CLASSIFICATION: RANGE:
DATE APPROVED:/PROCESSED POST EDITED AT RANGE
(for future reference)

Regional Director Evaluator

VI. DECS PROPER ACTION: