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Clearance Form: CS Form No. 7 Series of 2017

This document is a clearance form for an employee of DepEd Dolores-Don Severo Felismino ES. [1] It provides details of the employee's purpose for clearance which is an emergency travel abroad from March 21-31, 2019. [2] The employee's supervisors certify that she is cleared of all work-related accountabilities. [3] Various offices within the agency then certify whether the employee is cleared or not cleared of any money or property accountabilities. [4] The agency head then signs the form, certifying that the employee has no pending administrative cases.

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Maan Bautista
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103 views4 pages

Clearance Form: CS Form No. 7 Series of 2017

This document is a clearance form for an employee of DepEd Dolores-Don Severo Felismino ES. [1] It provides details of the employee's purpose for clearance which is an emergency travel abroad from March 21-31, 2019. [2] The employee's supervisors certify that she is cleared of all work-related accountabilities. [3] Various offices within the agency then certify whether the employee is cleared or not cleared of any money or property accountabilities. [4] The agency head then signs the form, certifying that the employee has no pending administrative cases.

Uploaded by

Maan Bautista
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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CS Form No.

7
Series
Seriesofof2017
2017
Agency Name
CLEARANCE FORM
(Instructions at the back)

I PURPOSE

FEBRUARY 20, 2019


Date of Application
TO: DEPED-DIVISION OF QUEZON
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Emergency Travel Abroad
March 21-31, 2019
Effectivity/Inclusive Period: __________________________________________________________

Office of Assignment: ____________________________


DepEd Dolores-Don Severo Felismino ES
______________________________________
MARINA TENORIO CASINAS
Position/SG/Step: ____________________________
EHT II/15/2
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
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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