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Teachers Clearance

This document is a teacher's clearance form from the Department of Education in the Philippines. It summarizes that the teacher has satisfactorily submitted all required reports and accounted for any money or property. It lists the various reports signed by school officials and contributions accounted for. It also includes an inventory of government property and textbooks in the classroom signed by the school property custodian. The teacher's signature and clearance by school administrators is required before the teacher's contact information and clearance date.

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Lovella Lazo
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245 views16 pages

Teachers Clearance

This document is a teacher's clearance form from the Department of Education in the Philippines. It summarizes that the teacher has satisfactorily submitted all required reports and accounted for any money or property. It lists the various reports signed by school officials and contributions accounted for. It also includes an inventory of government property and textbooks in the classroom signed by the school property custodian. The teacher's signature and clearance by school administrators is required before the teacher's contact information and clearance date.

Uploaded by

Lovella Lazo
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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Republic of the Philippines

Department of Education
Region X
Division of Cagayan De Oro City

1-Apr-16
Date

TEACHER'S CLEARANCE
The Schools Division Superintendent
This Division
Madam:
I have the honor to inform your good office that I have satisfactorily submitted all required
reports and accounted for all money and property for which I am responsible and duly attested
by the official signatures as shown below.
A. Required Reports
1. Report on Promotion(SF5)
2.Permanent Record (Form137)
3. Certificates/ Diploma
4.Form 138 (Report Cards)
5. SF 1
6. SF 4 ( For Assigned MTs per level)
7. SF 6 ( For GLs per Level)
8.SF 7 ( For GLs and MTs per level)
9. SALN, CY 2015
10. Community Tax Certificates 2016
11. IPCRF (S.Y.2015-2016)
12.Annual Physical Check-up
13. PRC License Number w/ Expiry Date
14. PDS REV.2005 ( CSC Form 212)
B. Financial/Property Accountabilities
1. Authorized Contributions

Signatory
Gr.Level& Sch.ICT Coordinator

School Head/MT Assigned


School Head Assigned
School Head Assigned
Gr.Level& Sch.ICT Coordinator

School Head Assigned


School Head Assigned
School Head Assigned
School Head Assigned
School Head Assigned
School Head Assigned
School Nurse
School Head Assigned
School Head Assigned
School Head Assigned
Amount

1.1. GSP Registration (Mrs Salazar)


1.2 BSP Registration ( Mr. Espinoza)
1.3 Red Cross
1.4 School Paper (Statement of Account)
1.5 United Way Tickets ( GLs)

2. Other Contributions
2.1. COPSTEA
2.2 OROTECC
2.3 Teachers' Club
2.4 Teachers' COOP
2.5 GPTA Contribution

3. Property Accountability Reports


3.1 Inventory of Gov't Property
donated by PTA,Graduating Class/Honor
Pupils/NGOs & etc.) left in the classroom
(comply in separate copies)
such as:
Classroom Keys
Desks/ chairs

Blackboard
Tables
Cabinets
Ceiling/wall fans
TV Sets/ DVD
Water Facilities/Electrical Features

Signature

Club Treasurer
COOP Treasurer
GPTA Treasurer

Sch. Property Custodian

* All entries should be signed by the official(s) even if unapplicable to the teacher.

3.2 Textbooks/Manuals and Instructional Materials


Titles Received

Quantity

Property Custodian

3.3Textbooks/Manuals and Instructional Materials LOST


Titles Received
Quantity

Property Custodian

Please attach official receipt issued by the Disbursing Officer or Affidavit of Loss
Until

JUNE 5, 2016
Date
My contact number is __________________ .

my address will be at ___________________________________________


Place

Very Truly yours,

Teacher's Signature Over Printed Name

Certified Correct:

Concurred:

JEMUEL M. GALAY

JEAN S. MACASERO,Ph.D.

Principal III

District In-charge

Recommending Approval:

REYNALDO E. MANUEL,JR.,Ph.D.,CESE
Assistant Schools Division Superintendent

Approved:

ELENA M. BORCILLO, CESO V


Schools Division Superintendent

Note: Please accomplish in four (4) copies: one for the teacher, one for the school, one for the

CS201 file in the Division Office and for the PIB Payroll.
llm2012

1-Apr-16
Date

Date Cleared

Coordinator/
School Head

Date Cleared

Date Cleared

Affidavit of Loss

____________
Place

Signature Over Printed Name

AN S. MACASERO,Ph.D.
District In-charge

, one for the

Republic of the Philippines


Department of Education
Region X
Division of Cagayan De Oro City

Date

TEACHER'S CLEARANCE
The Schools Division Superintendent
This Division
Madam:
I have the honor to inform your good office that I have satisfactorily submitted all required
reports and accounted for all money and property for which I am responsible and duly attested
by the official signatures as shown below.
A. Required Reports
1. Report on Promotion(Form 18-E)
2.Permanent Record (Form137)
3. Certificates/ Diploma
4.Form 138 (Report Cards)
5.Reports on Drop-outs (by Sex)
6.Reports on Failures (by Sex)
7.SALN (Statement of Assets,Liabilities
and Net Worth ,CY 2013)
8. Community Tax Certificates 2013
9. CB-PAST (S.Y.2012-2013)
10.Annual Physical Check-up
11. PRC License Number w/ Expiry Date
B. Financial/Property Accountabilities
1. Authorized Contributions

Signatory
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head

Amount

1.1. GSP Registration


1.2 BSP Registration
1.3 Red Cross
1.4 School Paper (Statement of Account)

1.5 Approved GPTA Contribution


(Statement of Account)
2. Other Contributions
2.1. COPSTEA
2.2 OROTECC
2.3 Teachers' Club /COOP
3. Property Accountability Reports
3.1 Inventory of Gov't Property
donated by PTA,Graduating Class/Honor
Pupils/NGOs & etc.) left in the classroom
(comply in separate copies)
such as:
Desks/ chairs
Blackboard
Tables
Cabinets
Ceiling/wall fans
TV Sets/ DVD
Water Facilities/Electrical Features

Sch. Property Custodian

Signature

* All entries should be signed by the official(s) even if unapplicable to the teacher.

Date

Date Cleared

Coordinator/
School Head

PSDS/Treasurer
of the Club

Republic of the Philippines


Department of Education
Region X
Division of Cagayan De Oro City

MARCH 31,2014
Date

TEACHER'S CLEARANCE
The Schools Division Superintendent
This Division
Madam:
I have the honor to inform your good office that I have satisfactorily submitted all required
reports and accounted for all money and property for which I am responsible and duly attested
by the official signatures as shown below.
A. Required Reports
1. Report on Promotion(Form 18-E/Form5)
2.Permanent Record (Form137)
3. Certificates/ Diploma
4.Form 138 (Report Cards)
5.Reports on Drop-outs (by Sex)
6.Reports on Failures (by Sex)
7.SALN (Statement of Assets,Liabilities
and Net Worth ,CY 2013)
8. Community Tax Certificates 2014
9. CB-PAST (S.Y.2013-2014)
10.Annual Physical Check-up
11. PRC License Number w/ Expiry Date
B. Financial/Property Accountabilities
1. Authorized Contributions

Signatory
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head
School Head

Amount

1.1. GSP Registration


1.2 BSP Registration
1.3 Red Cross
1.4 School Paper (Statement of Account)
1.5 Approved GPTA Contribution
(Statement of Account)
2. Other Contributions
2.1. COPSTEA
2.2 OROTECC
2.3 Teachers' Club /COOP
3. Property Accountability Reports
3.1 Inventory of Gov't Property
donated by PTA,Graduating Class/Honor
Pupils/NGOs & etc.) left in the classroom
(comply in separate copies)
such as:
Desks/ chairs
Blackboard
Tables
Cabinets
Ceiling/wall fans
TV Sets/ DVD
Water Facilities/Electrical Features

Sch. Property Custodian

Signature

* All entries should be signed by the official(s) even if unapplicable to the teacher.

3.2 Textbooks/Manuals and Instructional Materials


Titles Received

Quantity

Property Custodian

3.3Textbooks/Manuals and Instructional Materials LOST


Titles Received
Quantity

Property Custodian

Please attach official receipt issued by the Disbursing Officer or Affidavit of Loss
Until JUNE 9,2014
Date
My contact number is 09264853600.

my address will be at B27 L14 PN ROA SUBD.,CALAANAN,CDO


Place

Very Truly yours,

LOVELLA LAZO MAGRIA


Teacher's Signature Over Printed Name

Certified Correct:

Concurred:

CYNTHIA V. YAEZ

SHIRLEY A. MERIDA,Ph.D.,ESP-IV

Principal II

School Principal/District In-charge

Recommending Approval:

Assistant Schools Division Superintendent

Approved:

ELENA M. BORCILLO, CESO VI


Schools Division Superintendent

Note: Please accomplish in four (4) copies: one for the teacher, one for the school, one for the
CS201 file in the Division Office and for the PIB Payroll.

llm2014

MARCH 31,2014
Date

Date Cleared

Coordinator/
School Head

PSDS/Treasurer
of the Club

Date Cleared

Date Cleared

Affidavit of Loss

Place

LLA LAZO MAGRIA


Signature Over Printed Name

RIDA,Ph.D.,ESP-IV

l Principal/District In-charge

, one for the

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