2)-

214
CS Form No. 7
- Series of 2018
199Series of 2017
1

Deparment of Education
CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: Department of Education
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: ____________________________

______________________________________
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 Head of Office
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

b. Human Resource Welfare & Assistance

c. Agency-accredited Union/Cooperative
2. Library

a. Legal Office Library

b. Library Services
3. Finance and Assets Management

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

_________________________________
Signature over Printed Name of Agency Head
Page 1 of 2
CSC Form OSDS-AS-REC-001 rev0
Series of 2018
Republic of the Philippines
DEPARTMENT OF EDUCATION
Regional Office IX, Zamboanga Peninsula
Division of Zamboanga del Sur
Provincial Government Center, Dao, Pagadian City
Telefax: (062)-214-1991

CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: Department of Education
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave
Effectivity/Inclusive Period: __________________________________________________________

Office of Assignment: ____________________________

______________________________________
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.
_______________________________ _______________________________
School Head Head of Office/Supervisor
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not Name of Clearing
Name of Unit/Office/Department Cleared Cleared Officer/Official
Signature
1. Administration Sector
Supply and Property Procurement and BERNADETH R. GULBEN,
a. Management Services AO IV

b. Human Resource Welfare & Assistance EVA G. CASTRO, AO IV

c. Agency-accredited Union/Cooperative N/A
2. Library
a. Legal Office Library N/A
b. Library Services FEDILA V. ABAYA, LIB. II
3. Finance and Assets Management

a. FinancialTransaction,
Payroll, Services Processing & Billing MEJELYN L. BALUD, Acct. III
b. Services
MANUEL SHEAN N.
Remittance Services ROMARATE, AO II
4. Professional and Institutional Development
EBENEZER B. MALILAY JR.,
a. Scholarship Services SEPS, HRDD
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. Internal Affairs Office/Legal Affairs Office ATTY. JILL C. ALPECHE
with pending administrative case Attorney III
with ongoing investigation (no formal charge yet)

V CERTIFICATION

I hereby certify that this employee is cleared of work-related, money and properly accountabilities from this
agency. This certification includes no pending administrative case from this agency.

DR. JEANELYN A. ALEMAN, CESO V

Schools Division Superintendent
Signature over Printed Name of Agency Head
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.

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