Division

EQUIVALENT RECORD FORM

(Submit in Four Copies)

Name: _________________________________________________ Date of Birth: ______________ Gender: ______

(Surname) (Given Name) (Middle Name)

Employee No.: _______________________________ Authorized Position Title: ______________________________

Item No.: ___________________________ SG: ____ Authorized Annual Salary: ______________________________

I. Educational Attainment
Completed/ Units
Master's Degree Earned Name of Schools Year Completed Equivalent
(Write in full with specialization) (if not completed)

II. Years of Teaching Experience: _______________________

Private: _______________________
Public: _______________________

III. Training Attended

Number of
Title Inclusive Dates Sponsoring Agency
Hours

IV. For Head Teacher Positions and Other Related Teaching Positions
Years of Experience in Present Position:

V. Latest Performance Rating:

(Teacher's Signature)

VI. Schools Division Action (For Schools Division Evaluator Only)

Salary
Classification Date Processed Range Assignment Salary Schedule Remarks
Grade

NBC: _____ S. ____

Certified Correct: Recommending Approval:

JERIMAINE M. PEREZ IMELDA P. MACASPAC, PhD

Administrative Officer IV Assistant Schools Division Superintendent
Schools Division Evaluator Officer-in-Charge
Office of the Schools Division Superintendent
VII. DepEd Regional Office Action

Classification: Post Audited Assignment:

Date Processed: Salary Grade:
Salary Schedule:
Remarks:

Approved:

Evaluator