CS Form No.

7
Series
Series of 2017
of 2017 Republic of the Philippines
Department of Education
SCHOOLS DIVISION OF NUEVA ECIJA
Brgy. Rizal, Sta. Rosa, Nueva Ecija

DIVISION CLEARANCE FORM*

(Instructions at the back)

I PURPOSE

January 9, 2020
(Date of Application)

TO: The Schools Division Superintendent

DepEd, Schools Division of Nueva
Sta. Rosa, Nueva Ecija

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 SDO-CARRANGLAN ANNEX

RODELIO V. RAMISCAL
Position/SG/Step SCHOOL PRINCIPAL II (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.

TRANSFER FLORANTE M. ESCOSA, PH. D.

Purpose District Supervisor
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

a. Management Services ALBERTO V. TECSON
2. Library

b. Library Services JENNIFER P. BANAYAT

3. Finance and Assets Management
"
x
a. Financial Services (Accountant) MARAH M. PACSON

c. Payroll & Remittance Services (Cashier II) GLACIE B. DE LEON

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office ATTY. ARNOLD G. ONIA

with pending administrative case
with ongoing investigation (no formal charge yet)

V CERTIFICATION

JESSIE D. FERRER, CESO V.

Document Code: SDO-QF-OSDS-PER-DIVCLRNCE-035 Revision: 00
Schools Division Superintendent Effectivity Date: 07-13-2018

*submit in 4 Copies Page 1 of 2

rra2017
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
 Republic of the Philippines
Department of Education
DIVISION OF NUEVA ECIJA
SDO-CARRANGLAN ANNEX
Carranglan, Nueva Ecija
-o0o-
ELEMENTARY

SCHOOL CLEARANCE*

I PURPOSE

January 9, 2020
(Date of Application)
TO WHOM IT MAY CONCERN:

I hereby CERTIFY that Mr./Mrs./Miss RODELIO V. RAMISCAL

SCHOOL PRINCIPAL II of CARRANGLAN CENTRAL SCHOOL

(Position) (School)

with Unique Item Number OSEC-DECSB- SP2-150015-2019

Page No. is cleared from MONEY, PROPERTY and WORK-RELATED ACCOUNTABILITIES for:

Purpose: £ Transfer £ Resignation £ Other Mode of Separation:

£ Retirement £ Leave Please specify:

Effectivity/Inclusive Period:

RODELIO V. RAMISCAL
(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.

FLORANTE M. ESCOSA Ph. D.

District Supervisor

III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES

Not
Name of Unit/Office/Department Cleared
Cleared Name of Clearing Officer/Official
1. Property

a. Supply Officer I/Property Custodian MIRASOL B. REYES

 b. District Property Custodian RIENHARD D. VENTURINA
2. School Forms

a. President, Teacher's Club RONALDO S. DELIZO

3. Financial

a. School Treasurer BLESSIE A. TOMAS

b. District Treasurer ROSELLE DL. PALOMO

*submit in 4 Copies
rra2017
rtment of Education
ON OF NUEVA ECIJA
RRANGLAN ANNEX
nglan, Nueva Ecija
-o0o-

L CLEARANCE*

January 9, 2020
(Date of Application)

a permanent

CARRANGLAN CENTRAL SCHOOL

PSIPOP FY 2018

PERTY and WORK-RELATED ACCOUNTABILITIES for:

RODELIO V. RAMISCAL
(Name and Signature of Employee)

ork-related accountabilities from this Unit/Office/Dept.

FLORANTE M. ESCOSA Ph. D.

District Supervisor

Signature
Page 1 of 2