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Employee Clearance Form

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0% found this document useful (0 votes)

69 views

Employee Clearance Form

Uploaded by

joseph barbosa

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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Medgate

4F Dolmar Gold Tower,

107 C. Palanca Street
Legaspi Village, Makati City
T +63 2 8424 1747
medgate.ph

Employee Clearance Form

This form shall be filled out by the exiting employee. This shall be routed to all departments and
submitted to Human Resource for processing of final pay.

Non-completion of the clearance form due to failure of the employee to settle certain
accountabilities or submit the required documents shall be ground for withholding of his final pay.

Employee Information

Last Name: Barbosa First Name: Jaslyn May

Position Held: Telemedical Assistant ID No.:

Date Hired: October 3, 2022 Date Separated:

Last Day of Work: March 10, 2023 Immediate Superior:

Departments

IT Operations

Particulars Cleared Pending / With Remarks

Charges

Computer Equipment n/a

Headset S/N
Cleared 1RHY1F 2AG556

RD/ RDP Account Cleared

3CX Account
Cleared
Domain Account
Cleared
E-mail Access Cleared
Biometrics Access
n/a
Others:

Cleared by / Date:
Alexter Tumangan 03-11-23
Originating Department

Turnover Completed

Cleared by / Date:
Human Resource

Locker Key

Employee Manual/
Code of Conduct

Health Card

Company ID

Exit Interview

Cleared by / Date:

Finance and Admin

Property/Docs/Etc.

Filing Cabinet Keys

Mobile Phone

Cash Advances

Loans

Others:

Cleared by / Date:

Date Resignation Letter Received

I certify the above listed information to be true and correct.

Signature of Departing Employee: Date:

Approved by Department Manager: Date:

cc: Originating Department

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Employee Clearance Form

Uploaded by

Employee Clearance Form

Uploaded by

Medgate

4F Dolmar Gold Tower,

Employee Clearance Form

Last Name: Barbosa First Name: Jaslyn May

Position Held: Telemedical Assistant ID No.:

Date Hired: October 3, 2022 Date Separated:

Last Day of Work: March 10, 2023 Immediate Superior:

Particulars Cleared Pending / With Remarks

Computer Equipment n/a

RD/ RDP Account Cleared

Finance and Admin

Filing Cabinet Keys

Date Resignation Letter Received

I certify the above listed information to be true and correct.

Signature of Departing Employee: Date:

Approved by Department Manager: Date:

cc: Originating Department

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