Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OF ILOCOS SUR

NAME ________________________________________________ DATE OF BIRTH __________ GENDER

_______
Surname Given M.I.
EMPLOYEE NO.: __________________ AUTHORIZED POSITION TITLE:
_______________________________
ITEM NO.: ___________________________ AUTHORIZED SALARY:
_____________________________________

I. EDUCATIONAL ATTAINMENT & CIVIL SERVICE ELIGIBILITY

DEGREE OR
CIVIL SERVICE
HIGHEST NAME OF SCHOOL
EXAM/PBET/L DATE OF EXAM
DEGREE INSTITUTION YEAR
ET
ATTAINED

II. SERVICE RECORDS: ATTACHED DULY CERTIFIED SERVICE RECORD

III. EQUIVALENT UNITS
A. Total No. of Years in Teaching (Public Only) ______________ Equivalent _____________
B. Degree to Degree Equivalent (Present Degree) ___________ Equivalent _____________

C. AREAS OF EQUIVALENT SCHOOL YEAR NO. OF UNITS DESCRIPTION

1. Professional Study
2. Teaching Experience
a. Public School Equiv. C.A. for
b. Private School Length of Service
3. Adm. Supervisory
a. Public School
b. Private School
4. Other
(Seminar/Workshop/
Training, etc.)
TOTAL
Latest Efficiency Rating: __________________

_______________________ ________________________________________
Teacher’s Signature School Principal/Public Schools District Supervisor
_____________________________________________________________________________________
NOTE: Teachers do not write below

IV. DIVISION ACTION:

Date Grade Salary Scheduled
Classification Remarks
Processed Assignment Grade Salary

CERTIFIED CORRECT: RECOMMENDING APPROVAL:

LYSANDER N. ESPEJO, PhD

Administrative Officer V

V. DepEd Regional Office Action

Classification: __________________________________ Salary Grade ________________
Date approved/Processed: ________________ Post-Audited at Salary Grade: ___________

Reviewed by:

*APPROVED:
HERMINIA F. ANWOJU
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OF ILOCOS SUR

Teacher Credentials Evaluator II

RHODA T. RAZON, EdD, CESO IV
Assistant Regional Director
*THE APPROVAL OF THE EQUIVALENT RECORD
FORM IS AUTOMATICALLY CANCELLED IF HIS/HER
RECORDS UPON WHICH THE APPROVAL IS BASED
ARE LATER FOUND FICTITIOUS OR FRAUDULENT.