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Republic of the Philippines

Department of Education
MIMAROPA Region
Meralco Ave. Cor. St. Paul Road
Pasig City

District/School ____________________________________________________

EQUIVALENT RECORD FORM


Name: ____________________________________________________________ Date of Birth: __________________
(Surname) (Given) (M.I.)
Employee No: ___________________________________ Authorized Position Title: ____________________________
Item Mo: _____________________ P.D. No. _______________________ Authorized Salary: __________________
I. EDUCATIONAL ATTAINMENT and CIVIL SERVICE ELIGIBILITY

Title, Degree or Highest Attained Name of Institution Year Received Civil Service Rating Date
Examination

II. SERVICE RECORD ATTACHED DULY CERTIFIED SERVICE RECORD


III. EQUIVALENT UNITS
A. Total no. of years teaching (Public Only) _____________ ________________ _____________
B. Degree to degree equivalent (Present Degrees) _____________ _________________ _____________
C. Areas Equivalent School Year No. of Units Descriptions
D. Professional Study _____________ ________________ _____________
E. Teaching Experience
a. Public School _____________ ________________ _____________
b. Private School _____________ ________________ _____________
1. Adm. Supervisory Experience
a. Public School _____________ ________________ _____________
b. Private School _____________ ________________ _____________
2. Others (Seminars, workshop, etc) _____________ ________________ _____________
TOTAL _____________ ________________ _____________
LATEST EFFICIENCY RATING: _________________________
RECOMMENDING APPROVAL:

_______________________ ________________________
Principal Teacher’s Signature

NOTE: TEACHERS DO NOT WRITE BELOW


IV.DIVISION ACTION Date Processed Range Salary Ranged Scheduled Salary Remarks
CLASSIFICATION Assignment

Recommending Approval: Certified Correct:

MARIA LUISA D. SERVANDO, Ph.D., CESO IV KRYSTEL CHARISMA L. JUMANOY


OIC-Schools Division Superintendent Administrative OFFICER IV, HRMO II

V. DEPED REGIONAL ACTION


Classification: ________________________ Range:____________________________
Date of Approval/Processed: ____________

GILBERT T. SADSAD, Ph.D. TEODORICO O. SALIDO III


OIC- Regional Director Evaluator

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