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Clearance Form: CS Form No. 7 Revised 2018

This document is a clearance form used by the DepEd Misamis Oriental Division Office. It consists of 5 sections: I. Purpose - for the employee to specify their reason for separation and effective date. II. Clearance from work-related accountabilities by the employee's immediate supervisor. III. Clearance from money and property accountabilities by various clearing officers in different offices. IV. Certification of no pending administrative cases by the Assistant Schools Division Superintendent. V. Final certification by the Schools Division Superintendent that the employee has been cleared of all responsibilities and has no pending cases.

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383 views1 page

Clearance Form: CS Form No. 7 Revised 2018

This document is a clearance form used by the DepEd Misamis Oriental Division Office. It consists of 5 sections: I. Purpose - for the employee to specify their reason for separation and effective date. II. Clearance from work-related accountabilities by the employee's immediate supervisor. III. Clearance from money and property accountabilities by various clearing officers in different offices. IV. Certification of no pending administrative cases by the Assistant Schools Division Superintendent. V. Final certification by the Schools Division Superintendent that the employee has been cleared of all responsibilities and has no pending cases.

Uploaded by

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

7
Revised 2018

CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: DEPED MISAMIS ORIENTAL DIVISION OFFICE
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose:  Transfer  Resignation  Other Mode of Separation:
 Retirement  Leave  With Pay Please specify:
 Without Pay
Effectivity/Inclusive Period:

Office of Assignment:
District/Address:
Position/SG/Step Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
I hereby certify that this applicant is cleared of work-related accountabilities from this School/Unit/Section/Office/Division:

School Head/PSDS/DIC/Section Head/Division Chief


Immediate Supervisor
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES NOT
CLEARED
CLEARED Name of Clearing Officer/Official Signature/Date
Name of Unit/Section/Office/Department
Please check ( ✓)
1. Administration Sector
a. Supply & Property Procurement Management Section: ELEONOR P. CRUZ
As to supply & property procurement responsibility AO IV - Supply Officer
b. Human Resource Management/Personnel Section: MELANIE C. ESTENZO
As to human resource welfare & assistance, AO IV - HRM Officer
c. MODOECCO Office: MILA A. JANUBAS
As to Agency-accredited Union/Cooperative Agriculturist II, MODOECCO Treasurer
2. Administrative/Records
a. Records Section: INGRID C. HEBRON
As to filing of SALN, 201 files/records borrowed AO IV - Records Officer
b. Office of the Administrative Officer V RHODORA L. GALLARES
As to Administrative Services EPS I, OIC-Office of the AO V
3. Finance and Assets Management
a. Payroll Section: RHODORA L. GALLARES
As to Payroll & Remittance Services EPS I, OIC-Office of the AO V
b. Cashiering Section: MARRISA FAY S. JADAP
As to cash accountability AO IV - Cashier
c. Office of the Budget Officer: MARK LORREN T. TEJANO
As to budget accountability & Provident Fund AO V - Budget Officer
d. Office of the Accountant: ANGELITA S. RANALAN
As to cash advances & overpayment Accountant III
4. Professional and Institutional Development
a. Office of the Assistant Schools Division Superintendent: ROWENA H. PARA-ON
As to SGOD/CID/OSDS Division Services Assistant Schools Division Superintendent
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE
a. Internal Affairs Office/Legal Affairs Office: ROWENA H. PARA-ON
Assistant Schools Division Superintendent

with pending administrative case


with ongoing investigation (no formal charge yet)
V CERTIFICATION

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:

JONATHAN S. DELA PEÑA, PhD, CESO V


Schools Division Superintendent
Agency Head
Note: This form shall be provided by the Office of Assignment and shall be accomplished in 4 copies, A4-size Paper

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