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CS Form No. 7 Clearance Form

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12 views

CS Form No. 7 Clearance Form

Uploaded by

Benjie Beduya
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 of2018
Revised 2017
DEPARTMENT OF EDUCATION
SCHOOLS DIVISION OF CALBAYOG CITY
CLEARANCE FORM
(Instructions at the back)

I PURPOSE: Special Leave Benefits for Women-Sick Leave

07/16/2024
Date of Filing
TO: Department of Education, Regional Office VIII
I hereby request clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Date of Effectivity: __________________________________________________________
Office of Assignment Tinambacan Central School
CRISTINA C. GUHOL
Position/SG/Ste Master Teacher 2/ SG19/ 1 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this employee is cleared / not cleared of work-related accountabilities from this Unit/Office/Dept.

MICHAEL V. PERNIA ALMA R. CABER


Principal III Public Schools District Supervisor
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Particulars Cleared Not Cleared Name of Clearing Officer/Official Signature
1. Finance Services
On cash advance, accounts receivable, and SHERYLL ANN MARIE G. LACABA
a. travelling expenses paid in advance Accountant III

SHERYLL ANN MARIE G. LACABA


b. On cash Accountability Accountant III

SHERYLL ANN MARIE G. LACABA


c. On Provident Fund Loan Accountant III

2. Administrative Services
GRACE S. PAGUNSAN
a. On property Accountability Administrative Officer V

GRACE S. PAGUNSAN
b. On attendance records and salary overpayment Administrative Officer V

MARIA ANGELA B. ANTONIO


c. On records borrowed Administrative Officer IV

3 Library Services
BEVERLY C. LONGCOP
a. On books/materials borrowed Librarian

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:


a. with pending administrative case ATTY. MARIA CATHERINE S. BARANDINO
b. with ongoing investigation (no formal charge yet) Attorney III

V CERTIFICATION
This is to 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.

Approved:

MARGARITO A. CADAYONA JR. PHD, CESO VI


OIC - 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 leave of absence for more than 30 days
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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