Republika ng Pilipinas
Kagawaran ng Edukasyon
Rehiyon V
TANGGAPAN NG MGA PAARALANG PANSANGAY NG CAMARINES SUR
CS Form No. 7 Agency Name
Revised 2018
CLEARANCE FORM
GVR (Instructions at the back)
I PURPOSE
Date of Application
TO: Department of Education, Division of Camarines Sur
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: DEATH CLAIMS
Effectivity/Inclusive Period: __________________________________________________________
Office of Assignment: FAO:______________________
_____________________+ DECEASED
Position/SG/Step: 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.
Immediate Supervisor
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
a. Management Services BENJAMIN N. LAYOSA JR.
b. Human Resource Welfare & Assistance MARIA DIVINA H. CALLEJA, JD
c. Agency-accredited Union/Cooperative
2. Library
a. Legal Office Library N/A
b. Library Services ROWENA R. DEPOSITARIO
3. Finance and Assets Management
a. Financial Services KATHERINE M. ABASOLA
b. Transaction, Processing & Billing Services GERLIE V. CAÑAS, CPA
c. Payroll & Remittance Services JULIO B. TRANSONA
4. Professional and Institutional Development
a. Scholarship Services MA. SALVE III V. GUTIERREZ
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office ATTY. JINKY B. BATALLA-NOCOS
with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
NORMA B. SAMANTELA, CESO V
Signature over Printed Name of Agency Head
Address: Freedom Sports Complex, San Jose, Pili, Camarines Sur Page 1 of 2
Email:
[email protected] Website: www.depedcamsur.com
Telephone No: (telefax) 8713340
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.
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