Republic of the Philippines

Departmet of Education
Region VI - Western Visayas
DIVISION OF BACOLOD CITY
Bacolod City

EQUIVALENTS RECORD FORM

Name: ______________________________________________________Date of Birth: ____________________Sex: _______
(Surname) (Given Name) (Middle)
Employee No. _____________________________ Authorized Position Title: _______________________
Item No. _____________________ P.D. No. _______________ _ Authorized Salary: _____________________________

I. Educational Attainment & Civil Service Eligibility:

Titles, Degrees or Highest Name of Year Received Civil Service Rating Date
Grade Attained Institution Examination

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 of Equivalents : School Year : No. of Units : Description
1. Professional Study : ______________: ____________: __________________
2. Teaching Experience
a. Public School :______________: ____________ : __________________
b. Private School :______________: ____________ : __________________
3. Adm. Supervisory Experience
a. Public School :______________: ____________ : __________________
b. Private School :______________: ____________ : __________________
4. Others (Seminar, Workshop, etc.) : ______________________________________________
:_____________ : ____________ : __________________
TOTAL: ____________ : ____________ : __________________

LATEST EFFICIENCY RATING _______________________________

_____________________________
(Teachers Signature)
NOTE: TEACHERS DO NOT WRITE BELOW
IV. Division Action:
Classification Date Processed Grade Assignment Salary Grade Scheduled Salary REMARKS

RECOMMENDING APPROVAL: CERTIFIED CORRECT:

______________________________ _______________________________
Schools Division Superintendent Division Processing Officer

V. DepEd Regional Office Action:

REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION _________________________
REGION VI WESTERN VISAYAS CONTROL NO. _________________________
DURAN STREET, ILOILO CITY
POST AUDIT OF TEACHING POSITION
CLASS TITLE _____________________
SALARY GRADE ___________________
SUBJECT TO AVAILABILITY OF AN ITEM
______________________________
Teacher Credentials Evaluator
FOR THE REGIONAL DIRECTOR:
 Republic of the Philippines
Departmet of Education
Region VI - Western Visayas
DIVISION OF BACOLOD CITY
Bacolod City

SWORN STATEMENT

I hereby certify under oath that I have been actually enrolled in the school I
listed in the accompanying transcript of records that I have actually earned the units indicated
therein as required by the Bureau of Public Schools and has been furnished with authentic
copies of the sworn statements and its enclosures.

_________________________
Signature of Applicant

SUBSCRIBED AND SWORN TO before this _________ day of _________

affiant exhibiting his/ her Residence Certificate No. ____________________________ issued at
Bacolod City on ___________________________________.

NOVELYN M. VILCHEZ , Ph . D
OIC - Asst. Schools Division Superintendent

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