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PASIGIII/ FRANCISCO LEGASPI MEMORIAL SCHOOL

District/ School

EQUIVALENT RECORD FORM

Name:_________________________ ____________________Date of Birth:_______________


(Surname) (Given) (M.I.)
Employee No: _______________________________Authorized Position Title:_ TEACHER ______
Item No: __________________P.D. No._____________ ___Authorized Salary:_________________
I Educational Attainment and Civil Service Eligibility
Civil Service
Title, Degree or Highest Attained Name of Institution Year Examination Rating Date
Received

II. Service Record ATTACHED DULY CERTIFIED SERVICE RECORD


III. Equivalent Units
A. Total No. of years Teaching (Public only) ____________ _____________ ___________
B. Degree to degree equivalent (present degrees)____________ _____________ ___________
C. Areas Equivalent School Year No. of Units Descriptions

1. Professional Study ____________ _____________ ___________


2. Teaching Experience
a. Public school ____________ _____________ ___________
b. Private school ____________ _____________ ___________
3. Adm. Supervisory Experience ____________ _____________ ___________
a. Public school ____________ _____________ ___________
b. Private school ____________ _____________ ___________
4. Others (seminars, workshop, etc.) ____________ _____________ ___________
TOTAL ____________ _____________ ___________
LATEST EFFICIENCY RATING: ________VS________________
RECOMMENDING APPROVAL: _________________
Teacher’s Signature
MELVINA S. TARCENA
Principal

NOTE: Teachers do no write below


IV. Division Action Date Range Salary Ranged Scheduled Remarks
Classification Processed Assignment Salary

Recommending Approval: Certified Correct:

MA. EVALOU CONCEPCION A. AGUSTIN BENJAMIN C. JACOSALEM


Schools Division Superintendent- Officer In-Charge Administrative Officer V
V. DEPED Regional Office Action
Classification: __________________________ Range ___________________________
Date of approval/processed ______________ Post Audited Range ___________________________
(for future reference) ___________________________

______________________________________ __________________________________
Regional Director Evaluator
PROPER ACTION ________________________

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