CSFonnNo.

7
Sefties of21117

Republic of the Philippines

Department of Education
Region VII, Central V1511Yas
DIVISION OF CEBU CITY
CLEARANCE

I !PURPOSE:

Dale of Application
TO: WEPED. DIVISION OF CEBU CITYl
I hereby apply for clearance from money. property and worlHelalEd aa:ountabi1itie for:
Purpose: OTransfer 0 Resignation 0 Olller Mode of Separation:
0 Retirement 01..eave Please specify:
Effectivil.yAncfusive Period:

Office of Assignment

Position/SGIS1ep
Name and SigJlature of Employee

II ICl.EARANCE FROll WORK-RELATED ACCOUllTABILrnES

We hereby certify that this applicant is cleared of work-related accountabililie from this UnitfOfficelDept

Immediate "'· Head of Office I Princioal

RI ICLEARANCE FROM MONEY AND PROPER I 't ACCOUNTABILITIES
Name of UnitlOllicelllepa \aaanldl Not I Nameof
. OlficerlOfficial Signature
1. Adminislralion Sector
<>upptJ ..,.., rtuptnty . ......
Management Senrices (School Property
a 1 Custodian)
Supply and Property Prowrement and MA. CRISTINA L GACAYAN
a2Ma Services Division Supply Officer
RHOOORA S. MAN-ON
b. Human Resource Welrare & Assislance Pelsonnel Officer

c. . I -
FAVIOUTO 8- ALBERCA
NEU President
12- Libralv
a. Leaal Office limllv NIA

b. Librarv Services (School Librarian)

3_ Finance and Assets
JAENE P. AGUILA
a. Fmancial Services Aanuntant Ill
RIZALINA S. BACALSO
b. Transaction•. & Billino Services Cashier Ill
NIMFAM.KEE
c. Pmnnll & Remittance Services ADAS llllRemittance In-charge
4_ Professional and lnstitulkJnal
a. Scholarshio Services NIA
IV !CERTIFICATION OF NO PENDING ADmllSTRATNE CASE:
DANILO G_ GUDELOSAO Ed.D.
OIC-ASDS/ Chairman. Division
a. ln1emal Affairs.--...,,. --· Affairs Office Investigating Commillee

0 with pending administrative case

D with ongoing investigation (no formal charge yet)

IV ICERTIFICA TION

RHEA llAR A. ANGlUD, Ed. D.

. Schools Division Superintendent
Nole: SUlljecltolhepmllisiDrlofGAOCin:ularfln2,.__, ,,..,_.,.....-.-_ _ _ _ .,_""_s1111_mr _ _ propeny,
-~- . . natfl!l&Wllimh!rdlhes;old......._,._
Pagelo/Z
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 duty 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 offlcial 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 accountabilityfies from a

unit/office/department, the clearirYauthorizedofficial shaD attach to this
clearance the pertinent doa.ment/s that shaft 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 "Uncfeared" column. The clearing/aulhorized 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 accountabilityfteS 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 cet tifteate shall follow the order of number indicated.

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