Professional Documents
Culture Documents
7
Series of 2017 CITY SCHOOLS DIVISION OF DASMARIÑAS
CSDO Building, DASCA Compound, Burol II, Dasmarinas City
CLEARANCE FORM
(Instructions at the back)
I PURPOSE
Date of Application
TO: CITY SCHOOLS DIVISION OF DASMARINAS
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: __________________________________________________________
_______________________________ _______________________________
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 Services
MICAH P. ORTIZ
b. Records (as to 201 & other Records) Administrative Officer IV
AVELINA C. DESCALLAR
c. Cash (as to refund of Salary overpayment) Administrative Officer IV
MARICEL A. MENDOZA
d. Human Resource Welfare & Assistance Administrative Officer IV
GLADYS G. REYES
Administrative Officer V
2. Library
MARITES K. CHAVEZ
a. Library Services Librarian II
3. Medical Unit
a. Nurse-in-Charge
b. Dentist II
RAQUEL R. MOJICA
Accountant III
MYRNA C. REFORMADO
b. Budget Office Administrative Officer V
4. Professional and Institutional Development
V CERTIFICATION
MANUELA S. TOLENTINO,Ed.D.
OIC, Schools Division Superintendent
Signature over Printed Name of Agency Head
LS DIVISION OF DASMARIÑAS
CA Compound, Burol II, Dasmarinas City
EARANCE FORM
(Instructions at the back)
Date of Application
______________________________________
Name and Signature of Employee
_______________________________
Head of Office
Signature
and PROPERTY and other ACCOUNTABILITIES.
LA S. TOLENTINO,Ed.D.
ools Division Superintendent
over Printed Name of Agency Head
Page 1 of 2
INSTRUCTIONS:
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.)