CS Form No. 7 Clearance Formprincipal

CS Form No.
7
Series
Seriesofof2017
2017
A.P. GUEVARA INTEGRATED SCHOOL
CLEARANCE FORM
(Instructions at the back)
I PURPOSE
Date of Application
TO: SDO1 PANGASINAN
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 A.P. Guevara Integrated School

MA. VIOLA BURBOS - AGUSTIN, Ed.D.
Position/SG/St Principal 1/19/2 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
1. Administration Sector
Supply and Property Procurement and

a. Management Services SCHOOL PROPERTY CUSTODIAN
b. Human Resource Welfare & Assistance
c. Agency-accredited Union/Cooperative N/A

2. Library
N/A
a. Legal Office Library
LIBRARIAN
b. Library Services
3. Finance and Assets Management
a. Financial Services CASHIER/ SCHOOL TREASURER
b. Transaction, Processing & Billing Services PRESCILA A. MEJIA
c. Payroll & Remittance Services CASHIER/ SCHOOL TREASURER

4. Professional and Institutional Development
a. Scholarship Services N/A

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
ATTY. MC GUELVIN S.
a. Internal Affairs Office/Legal Affairs Office MACARAEG
with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICATION
TO WHOM IT MAY CONCERN:
This is to certify that MA. VIOLA B. AGUSTIN, P – I, of A.P. Guevara Integrated School has been cleared from monetary and pro
accountabilities for the school year 2019 – 2020.
This certification is being issued to MA. VIOLA B. AGUSTIN for her transfer of station.
MARILU N. CARDENAS
Assistant Schools Division Superintendent
RA INTEGRATED SCHOOL
ARANCE FORM
nstructions at the back)
Date of Application
Please specify: __________________________

_______________________________________________
MA. VIOLA BURBOS - AGUSTIN, Ed.D.

Name and Signature of Employee
of work-related accountabilities from this Unit/Office/Dept.
____________________
Head of Office
Signature
– I, of A.P. Guevara Integrated School has been cleared from monetary and property
for her transfer of station.
ILU N. CARDENAS
ools Division Superintendent
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.

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CS Form No.

Office of Assignment A.P. Guevara Integrated School

Supply and Property Procurement and

b. Human Resource Welfare & Assistance

c. Agency-accredited Union/Cooperative N/A

a. Financial Services CASHIER/ SCHOOL TREASURER

b. Transaction, Processing & Billing Services PRESCILA A. MEJIA

c. Payroll & Remittance Services CASHIER/ SCHOOL TREASURER

a. Scholarship Services N/A

Please specify: __________________________

MA. VIOLA BURBOS - AGUSTIN, Ed.D.

of work-related accountabilities from this Unit/Office/Dept.

for her transfer of station.

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

3. If the employees are cleared from a unit/office/department, the

4. If the employees appear to have uncleared accountability/ies from a

5. The HRMO shall distribute copies of approved clearance as follows: original

6. Processing of clearance certificate shall follow the order of number indicated.

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