Republic of the Philippines

DEPARTMENT OF EDUCATION
CARAGA REGION
Division of Surigao del Sur
Tandag City

EQUIVALENT RECORD FORM (ERF)

Name:_______________________________.___ Date of Birth:__________________ Sex: ______

(Surname) (Given) (M.I.)
Employee No:____________________Authorized Position Title: ____________________________
Item No: _________________________P.D. No.____________Actual Salary:_______________
I - Educational Attainment and Civil Service Eligibility
Year Civil Service
Titles, Degree or Highest Name of Institution Recei Examination Rating Date
Attained ved

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 degrees) ___________ Equivalent:___________
C. Areas Equivalent: ____________________________________________________________
School Year No. of Units Descriptions
1. Professional Study
2. Teaching Experience
a. Public school
b. Private school
3. Adm. / Supervisory Experience
a. Public school
b. Private school
4. Others (seminars, workshop, etc.)

TOTAL

LATEST EFFICIENCY RATING: __________________

__________________
Teacher’s Signature

CERTIFIED CORRECT:

WILLY C. DUMPIT, Ph.D., FRIEdr SHIRLENE E. CRABAJALES

SEPS/School Head Administrative Officer V
NOTE: Teachers do no write below
IV. Division Action Date Range Salary Ranged Scheduled Remarks
Classification Processed Assignment Salary

CERTIFIED CORRECT: APPROVED:

_____________________ JOSITA B. CARMEN, CESO V

Division Processing Officer Schools Division Superintendent
 O A T H

I HEREBY CERTIFY under oath that I have been actually enrolled in the school
or schools listed in accompanying transcript of record and that I have the units indicated therein.

As required the Bureau of Private Schools has been furnished with authentic
copies of the sworn statement and its enclosure.

_______________________________
Signature

SUBSCRIBED AND SWORN to before me this _________________day of

_______________201____ affiant exibiting his/her Residence Certificate No.____________.

Issued at_______________________________on _______________________________.

__________________________________
Signature of Person Administering Oath

Doc. No.__________________
Page No.__________________
Book No._________________
Series of__________________