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CS Form No. 7 Clearance Form 1

This 3 page document is a clearance form used by the Department of Education - Division of Batangas. It consists of 5 sections to document an employee's clearance from various accountabilities before transferring, resigning, retiring or going on leave. Section I is for employee details and purpose of clearance. Section II is for clearance from work-related accountabilities signed by the employee's supervisor and head of office. Section III is for clearance from money and property accountabilities signed by clearing officers of various units. Section IV is a certification of no pending administrative cases. Section V is the final certification signed by the Agency Head once all clearances are completed. Instructions are provided on page 3 for properly filling out and distributing the form.

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Mark Cañete Punongbayan
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9K views5 pages

CS Form No. 7 Clearance Form 1

This 3 page document is a clearance form used by the Department of Education - Division of Batangas. It consists of 5 sections to document an employee's clearance from various accountabilities before transferring, resigning, retiring or going on leave. Section I is for employee details and purpose of clearance. Section II is for clearance from work-related accountabilities signed by the employee's supervisor and head of office. Section III is for clearance from money and property accountabilities signed by clearing officers of various units. Section IV is a certification of no pending administrative cases. Section V is the final certification signed by the Agency Head once all clearances are completed. Instructions are provided on page 3 for properly filling out and distributing the form.

Uploaded by

Mark Cañete Punongbayan
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
You are on page 1/ 5

CS Form No.

7
Revised
Series of2018
2017
Department of Education - Division of Batangas
CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Filing
TO: Department of Education - Division of Batangas
I hereby request clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Date of Effectivity: __________________________________________________________

Office of Assignment: ____________________________


______________________________________
Position/SG/Step: ____________________________ Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this employee is cleared / not cleared of work-related accountabilities from this Unit/Office/Dept.

_______________________________ _______________________________
Immediate Supervisor Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Name of Unit/Office/Department Cleared Not Cleared Name of Clearing Officer/Official Signature
1. Administrative Services

a. Supply and Property Procurement and


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 C E R T I F I CAT I O N

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

Signature over Printed Name of Agency Head

Page 1 of 2
on - Division of Batangas
NCE FORM
s at the back)

______________________________________
Name and Signature of Employee

ed of work-related accountabilities from this Unit/Office/Dept.

Signature
d 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 leave of absence for more than 30
days 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

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