Republic of the Philippines

Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO OCCIDENTAL

EQUIVALENT RECORD FORM

Municipality: _____MALITA_________ School: ____BUHANGIN ELEMENTARY SCHOOL_____ District: MALITA NORTH____

Name: _____TIGAS NESSLEE JANE A.________________ Date of Birth: ________________ Sex:___

(Surname) (Given Name) (M.I.)

Employee No.________ Item Number: _______________________ Authorized Position Title:_____________

Page Number:____________________ Authorized Salary : __________________

I. EDUCATIONAL ATTAINMENT AND ELIGIBILITY:

Title, Degree or Highest Grade Name of Year Received Eligibility Rating Date
Attained Institution

II.SERVICE RECORD: Attached duly certified service record

III. EQUIVALENT UNITS:
A. Total No. of Years Teaching (public only) ______________ years.
B. Degree to Degree Equivalent (present degree) ___________ M.A Units
C.Areas of Equivalent School Year No. of Units/ Description
Years
1.Professional Study

___________________________________________
TOTAL ___________________________________________

2. Teaching Experience
a. Public School

b. Private School

Latest Efficiency Rating: _________________

______________________________
Teacher’s Signature
APPROVAL RECOMMENDED: _____________________________
School Principal IV/School Heads
IV. DIVISION ACTION:
CLASSIFICATION Date Processed Range Assignment Salary Grade Scheduled Salary Remarks

EVALUATED BY: CERTIFIED CORRECT:

ALOYSIUS CESAR C. BRAVO DR. JINKY B. FIRMAN, CESE

Administrative Officer V Assistant Schools Division Superintendent

APPROVED BY:

DR. LORENZO E. MENDOZA

Assistant Schools Division Superintendent
OIC-Schools Division Superintendent

‘TURNING YOUR VISIONS INTO REALITIES’

Lacaron, Malita, 8012 Davao Occidental
09663063411
depedoccidental@gmail.com
 Republic of the Philippines
Department of Education
REGION XI
SCHOOLS DIVISION OF DAVAO OCCIDENTAL

O A T H

I hereby certify under oath that I have actually enrolled in the school(s) listed in the accompanying
Transcript of Records and that I have earned the units indicated therein

____________________________________
SIGNATURE OVER PRINTED NAME

SUBSCRIBED AND SWORN TO BEFORE ME this ___________________, affiant exhibiting his/her

Community Tax Certificate No._____________________ issued at ______________ on ________________.

Doc. No. _________

Page No. ________ _________________________________
Book Bo. ________ Notary Public
Series of : ________