Department Memorandum 140 s.

1976

Republic of the Philippines

Department of Education
DepEd Region V

Division of ALBAY
School/District: ________________
Contact No.: __________________

EQUIVALENTS RECORD FORM

Name: ____________________________________________________________ Date of Birth: ____________________

(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 Highest Attained Name of Institution Year Received Civil Service Examination Rating Date

II. Service Records: ATTACHED DULY CERTIFIED SERVICE RECORD

III. Equivalent Units:
A. Total No. of Years Teaching (Public Only) _______________________ Equivalent ____________________
B. Degree to degree Equivalent (Present Degree) _______________________ Equivalent ____________________
C. Areas Equivalents: School Year No. of Units Description
1. Professional Study _________________ ___________ ____________
2. Teaching Experience
a. Public Schools _________________ ___________ ____________
b. Private Schools _________________ ___________ ____________
3. Adm. Supervisory Experience
a. Public Schools _________________ ___________ ____________
b. Private Schools _________________ ___________ ____________
4. Others (seminars, workshop, etc.) _________________ ___________ ____________
TOTAL _________________ ___________ ____________
Latest IPCRF rating: _________
______________________________
Teacher’s Signature
NOTE: Teachers do not write below
IV. Division Action
Classification Date Processed Range Assignment Salary Range Schedule Salary Remarks

CERTIFIED CORRECT: RECOMMENDING APPROVAL:

MARIANNE B. BUSTAMANTE NENE ROSAL-MERIOLES, CESO V

Administrative Officer IV Schools Division Superintendent
Division Processing Officer

V. DEPED Regional Office Action

Classification: __________________________________ Range: _________________________________
Date of Approval/Processed: ______________________ Post Audited Range: ______________________
(for future references) ____________________

__________________________________ _______________________________
Regional Director Teacher Credentials Evaluator II

VI. DEPED Proper Action ____________________________________

 Republic of the Philippines
Department of Education
Region V
DIVISION OF ALBAY
Bogtong, Legazpi City

TO WHOM IT MAY CONCERN:

I HEREBY CERTIFY, under oath that I have actually enrolled in the schools listed in the
accompanying transcript of records and that I have actually earned the units indicated therein. As
required, the BUREAU OF HIGHER EDUCATION has been furnished with authentic copies of this
statement and its enclosure.

______________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___________day of ___________________,

20_____, affiant exhibited to me her/his Residence Certificate No. ___________________________
issued at _____________________ on __________________________________, 20___.

_____________________________________
Administering Officer