Republic of the Philippines

Department of Education
Region II
DIVISION OF CAGAYAN
District/School

EQUIVALENT RECORD FORM

Name: Date of Birth: Sex:
(Surname) (Given Name) (M.I)
Employee No.: Authorized Position Title:
Item No.: P.D. No.: Authorized Salary:

I. Educational Attainment and Civil Service Eligibility:

Title Degree or Civil

Year
Highest Grade Name of Institution Service Rating Date
Received
Attainment Examination

II. Service Records: ATTACHED DULY CERTIFIED SERVICE RECORD

III. Equivalent Units:
A. Total No. of Year (Public Only) Equivalent:

B. Degree to Degree Equivalent: (Present Degree) Equivalent:

C. Area Equivalent:

No. of
School Year Description
Units
1. Professional Study
2. Teaching Experience
a. Public School
b. Private School
3. Adm. Supervisor Exp.
a. Public School
b. Private School
4. Other (Seminars, Workshops,
etc.)
TOTAL

IV. LATEST EFFICIENCY RATINGS:

Certified Correct:

District Supervisor/Principal Teacher’s Signature

RANGE SALARY SHEDULED

CLASSIFICATION DATE REMARKS
ASSIGNMENT RANGE SALARY

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

Schools Division Superintendent Division Processing Officer

V. DepEd Regional Office Action

Classification Range