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CSC Clearance Form

This clearance form from the Department of Education Region IV - CALABARZON Schools Division of Laguna is used to certify that an employee transferring, retiring, or otherwise leaving is cleared of any work-related, financial, or legal accountabilities. The form requires signatures from an employee's supervisor and various department heads to verify clearance from specific responsibilities. Instructions are provided on using the form and distributing copies for payroll and record-keeping purposes.

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Keizel Camille Mhardie Salvador
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103 views

CSC Clearance Form

This clearance form from the Department of Education Region IV - CALABARZON Schools Division of Laguna is used to certify that an employee transferring, retiring, or otherwise leaving is cleared of any work-related, financial, or legal accountabilities. The form requires signatures from an employee's supervisor and various department heads to verify clearance from specific responsibilities. Instructions are provided on using the form and distributing copies for payroll and record-keeping purposes.

Uploaded by

Keizel Camille Mhardie Salvador
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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CS Form No.

7
Series
Seriesofof2017
2017 Republic of the Philippines
Department of Education
Region IV - CALABARZON
SCHOOLS DIVISION OF LAGUNA
Sta. Cruz
CLEARANCE FORM
(Instructions at the back)

I PURPOSE:

Date of Application
TO: DEPED - SDO LAGUNA
(Agency Name)
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: GOV. FT. SAN LUIS ISHS


______________________________________
Position/SG/Step: TEACHER III/13/1 Name and Signature of Employee
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
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector

Supply and Property Procurement and LUISITO B. DE LA TORRE JR.


a. Management Services Administrative Officer IV

ANGELA F. LATINA
b. Human Resource Welfare & Assistance Administrative Officer V

c. Agency-accredited Union/Cooperative
2. Library

a. Legal Office Library

b. Library Services
3. Finance and Assets Management

IRENE A. FERNANDEZ
a. Financial Services Accountant III

IRENE A. FERNANDEZ
b. Transaction, Processing & Billing Services Accountant III

IRENE A. FERNANDEZ
c. Payroll & Remittance Services Accountant III
4. Professional and Institutional Development

a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

ATTY. MARY GRACE A. CHECA- HINOJOSA


a. Internal Affairs Office/Legal Affairs Office ATTORNEY III

with pending administrative case


with ongoing investigation (no formal charge yet)

V CERTIFICATION

EDITHA M. ATENDIDO, CESO V


Schools Division Superintendent
Signature over Printed 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 maternity leave of 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 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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