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Clearance Form: 1. Administration Sector

This document is a clearance form used by the Department of Education in Zamboanga del Norte, Philippines. The form is used to clear employees of financial obligations and accountabilities upon transfer, resignation, retirement, or other separation from their position. It requires signatures from the employee's supervisor and head of office to clear them of work-related obligations, and signatures from various department heads to clear any outstanding financial or property issues. Instructions on the back explain that employees must complete the form in quadruplicate before receiving their final salary payment and that it must be fully signed off on to certify they have no pending debts or accountability issues.

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154 views3 pages

Clearance Form: 1. Administration Sector

This document is a clearance form used by the Department of Education in Zamboanga del Norte, Philippines. The form is used to clear employees of financial obligations and accountabilities upon transfer, resignation, retirement, or other separation from their position. It requires signatures from the employee's supervisor and head of office to clear them of work-related obligations, and signatures from various department heads to clear any outstanding financial or property issues. Instructions on the back explain that employees must complete the form in quadruplicate before receiving their final salary payment and that it must be fully signed off on to certify they have no pending debts or accountability issues.

Uploaded by

chelsea kayle licomes fuentes
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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DIVISION OF ZAMBOANGA DEL NORTE

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 Employees


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
Name of Unit/Office/Department Cleared Name of Clearing Signature
Not Cleared Officer/Official
1. Administration Sector
a. Supply and Property Procurement and
Management Services
JUN LEONARD U. ROMARATE
Administrative Officer (V-Supply

b. Human Resource Welfare & Assistance ROBERT L. POCULAN III


SEPS-HRD
c. Agency-accredited Union/Cooperative
2. Library Services
a. Legal Office Library

b. Library Services MARIPIL T. GREGORIO


LIBRARIAN II
3. Finance and Assets Management
a. Financial Services ARVIE M. OMPOY, CPA
ACCOUNTANT II

b. Transaction, Processing & Billing Services ARVIE M. OMPOY, CPA


ACCOUNTANT II

c. Payroll & Remittance Services ARVIE M. OMPOY, CPA


ACCOUNTANT II
4. Professional and Institutional Development
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
a. internal Affairs Office/Legal Affairs Office ATTY. REY P. JANOLINO, JR.
ATTORNEY III
꙱ with pending administrative case
꙱ with ongoing investigation (no formal charge yet)
V CERTIFICATION

VIRGILIO P. BATAN JR., CESO IV


Schools Division Superintendent
INSTRUCTIONS:

1 Employees who are retiring, being separated, transferring to other agencies,


leaving the Philippines and going on maternity leave 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 oblgation 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 correspnding to their name once the employee
have complied the necessary requirement 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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