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Division-Clearance-Form Travel Abroad

This document is a clearance form from the Department of Education of the Philippines. The form provides details for an employee seeking clearance for purposes like transfer, resignation, or retirement. It outlines the process for clearing responsibilities and certifying no pending administrative cases from various offices to complete the clearance.

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DAISY ANTIMOR
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346 views3 pages

Division-Clearance-Form Travel Abroad

This document is a clearance form from the Department of Education of the Philippines. The form provides details for an employee seeking clearance for purposes like transfer, resignation, or retirement. It outlines the process for clearing responsibilities and certifying no pending administrative cases from various offices to complete the clearance.

Uploaded by

DAISY ANTIMOR
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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Republic of the Philippines

CS Form No. 7
Series of 2017 DEPARTMENT OF EDUCATION
Region XI
SCHOOLS DIVISION OF DAVAO CITY

CLEARANCE FORM
I PURPOSE
April 1, 2024
Date of Application
TO:
REYNANTE A. SOLITARIO, CESO VI
Schools Division Superintendent
Division of Davao City

I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Travel Abroad Please specify:
Effectivity/Inclusive Period: June 14 to June 26, 2024

Office of Assignment: MATINA APLAYA ELEM. SCHOOL


DAISY ANTIMOR-LEONARD
Position/SG/Step: Teacher I/ SG11/ Step 3 Signature over printed name of the applicant
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES

We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.

JASPER RAY T. MANCIO EVANGELINE A. VICENCIO


School Head / SIC / Division Chief District Supervisor (for Elementary/Kinder only)
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Name of Clearing
Name of Unit/Office/Department Cleared Not Cleared
Officer/Official
Signature
1. Library Services
a. (BOLTON LIBRARY) District 1 & 3 (a) ROSALIE G. ANTIPUESTO

OR
b. (TIBUNGCO LIBRARY HUB) District 2 (b) VENUS L. DE CASTRO
2 Administrative Office

a. Property and Supply Section FRANCISCO P. PANCHO


Admin. Officer IV
3 Finance

a. Provident Loan and Cash Advance ARMANDO D. DALISAY, JR.


Accountant III
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
Atty. IMMACULATE G. CLARK
a. Internal Affairs Office/Legal Affairs Office
Attorney III
with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION

This clearance is issued upon the request of _____________________________, which covers until the
above stipulated date. Any disallowances that may be found later shall held the requesting individual
responsible to settle upon demand.

REYNANTE A. SOLITARIO, CESO VI


Schools Division Superintendent
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.


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