Republic of the PhilippinesDEPARTMENT OF EDUCATION

Region XDIVISION OF MISAMIS ORIENTAL

Cagayan de Oro City

EQUIVALENT RECORD FORM

Name: _____________________________________________ Employee #: ____________ (Surname) (Given Name) (Middle) Item No.: _______________

I. Educational Attainment and Civil Service Eligibility:Title/Degree/

Highest Grade

Attained

Name of InstitutionYear

ReceivedCivil Service

ExamRating Date

II. Service Record Attached Duly Certified Service Record:Equivalent Units:

a. Total Number of Year Teaching Public Only: _________ Equivalent: ________ b. Degree to Degree Equivalent Present Degree: __________ Equivalent: ________c. Areas Equivalent

1. Professional Study2. Service on Professional

Committees3. Education Travel4. Working Experience5. Related Study or Teaching in

Service6. Teaching Experiences: a. Public Schools ____________________7. Training Courses ____________________8. Authorship ____________________9. Admin. Supervisory Experience a. Public Schools ____________________ b. Private Schools ____________________10. Others ____________________ TOTAL ____________________ Latest Performance -Efficiency Rating ____________________

__________________ (Teachers Signature)

__________________ PSDS/Principal/SIC

NOTE: TEACHERS PLS. DO NOT WRITE BELOWIII. Division Action:

ClassificationDate

ProcessedPreparation Salary Range Scheduled Salary Remarks

Recommending Approval: Certified Correct:

___________________________ BERNADETTE P. SAMACO Schools Division Superintendent Administrative Officer

IV. DepEd Regional Office Action:

Classification: ___________________________________ Range: ______________________Date Approved Processed: _________________________ Post Audited at Range __________

___________________________ ___________________________ (Regional Director) (Evaluator)

V. DepEd Proper Action:

School YearNo. of Units

Description