School Clearance Form 1

CS Form No.
7 DEPARTMENT OF EDUCATION
Series of 2017 LEYTE DIVISION OFFICE
SCHOOL CLEARANCE FORM
(Instructions at the back)
I PURPOSE Maternity Leave
December
November11, 2023
3, 2020
TO: DEPARTMENT OF EDUCATION Date of Application
(Name of Agency)
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £PLeave Please specify: __________________________
Effectivity/Inclusive Period: __________________________________________________________
Office of Assignment Barugo National High School

DAINA P. GARSAIN
Position/SG/St Teacher I/SG-11/Step 1 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
JENNYLIND C. UYSON MACARIO B. MESIAS

Filipino Department Head School Head
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector
Supply and Property Procurement and JEANETTE E. QUILAQUIL

P Property Custodian
a. Management Services
b. Human Resource Welfare & Assistance
c. Agency-accredited Union/Cooperative
2. Library
a. Legal Office Library

DAINA P. GARSAIN
P Library in-charge
b. Library Services
3. Finance and Assets Management
KIMVERLY RUSS A. ACOL
P Senior Bookkeeper
a. Financial Services
b. Transaction, Processing & Billing Services
c. Payroll & Remittance Services

4. Professional and Institutional Development
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office

with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
MARIZA S. MAGAN EdD, CESO V

Schools Division Superintendent
Page 1 of 2
INSTRUCTIONS:
1. Employees who are retiring, being separated, transferring to other agencies,

leaving the Philippines and going on maternity leave of absence shall prepare
this form in quadruplicate.
2. This clearance should be duly accomplished before paying the last salary or
any money due the employees. (Specify which type of clearance: maternity
leave, retirement, transfer, etc.)
3. If the employees are cleared from a unit/office/department, the

clearing/authorized official may attach to this clearance the pertinent
document/s that shall prove that the employees are cleared of any obligation
or accountability from their office, if any, and tick the box under the "Cleared"
column before affixing their signatures.
4. If the employees appear to have uncleared accountability/ies from a

unit/office/department, the clearing/authorized official shall attach to this
clearance the pertinent document/s that shall prove that the employees have
remaining obligation or accountability from their office further indicating the
necessary action/s that the employee must satisfy in order to be cleared, and
tick the box under the "Uncleared" column. The clearing/authorized official
must only sign this clearance corresponding to their name once the employee
have complied the necessary requirements and cleared of all the obligation/s
and accountability/ies from their office. They must also tick the box under the
"Cleared" column.
5. The HRMO shall distribute copies of approved clearance as follows: original to

the employee; duplicate to be attached to the payroll or voucher; triplicate to
human resource unit file; and fourth copy to accounting/auditing office.
6. Processing of clearance certificate shall follow the order of number indicated.
Page 2 of 2
CS Form No. 7 DEPARTMENT OF EDUCATION
Series of 2017 LEYTE DIVISION OFFICE
SCHOOL CLEARANCE FORM
(Instructions at the back)
I PURPOSE Transfer of Station
July 12, 2021

November 3, 2020
TO: DEPARTMENT OF EDUCATION Date of Application
(Name of Agency)
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Effectivity/Inclusive Period: __________________________________________________________
Office of Assignment Barugo National High School

PAULINE D. SALAZAR
Position/SG/St ADAS II/SG-8/Step 2 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
I hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
EVANGELINE C. MERCADO
School Head
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector
Supply and Property Procurement and

JEANETTE E. QUILAQUIL
Property Custodian
a. Management Services
b. Human Resource Welfare & Assistance
c. Agency-accredited Union/Cooperative
2. Library
a. Legal Office Library

CARINA L. QUIDLAT
Library in-charge
b. Library Services
3. Finance and Assets Management
KIMVERLY RUSS A. ACOL
Senior Bookkeeper
a. Financial Services
AIMEE A. FIGURO
Disbursing Officer
b. Transaction, Processing & Billing Services
c. Payroll & Remittance Services

4. Professional and Institutional Development
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office

with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
MANUEL P. ALBAŇO, PhD, CESO V

Schools Division Superintendent
Page 1 of 2

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CS Form No.

I PURPOSE Maternity Leave

Office of Assignment Barugo National High School

JENNYLIND C. UYSON MACARIO B. MESIAS

Supply and Property Procurement and JEANETTE E. QUILAQUIL

b. Human Resource Welfare & Assistance

a. Legal Office Library

b. Transaction, Processing & Billing Services

c. Payroll & Remittance Services

a. Internal Affairs Office/Legal Affairs Office

MARIZA S. MAGAN EdD, CESO V

1. Employees who are retiring, being separated, transferring to other agencies,

3. If the employees are cleared from a unit/office/department, the

4. If the employees appear to have uncleared accountability/ies from a

5. The HRMO shall distribute copies of approved clearance as follows: original to

6. Processing of clearance certificate shall follow the order of number indicated.

I PURPOSE Transfer of Station

July 12, 2021

Office of Assignment Barugo National High School

Supply and Property Procurement and

b. Human Resource Welfare & Assistance

a. Legal Office Library

c. Payroll & Remittance Services

a. Internal Affairs Office/Legal Affairs Office

MANUEL P. ALBAŇO, PhD, CESO V

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