CS Form No.

Revised 2018 TAGBINA DISTRICT II

DEPED- DIVISION OF SURIGAO DEL SUR
CLEARANCE FORM
I PURPOSE: for applying Teacher I Position
APRIL 23, 2021
Date of Application
TO: DEPED- DIVISION OF SURIGAO DEL SUR
I hereby apply for clearance from money, properly and work-related accountabilities for:
Purpose: Transfer Resignation Other Mode of Separation:

Retirement Leave Please specify: ________________________

Effectivity/Inclusive Period :
Office of Assignment : CARPENITO INTEGRATED SCHOOL JOAN LICAROS
Position/SG/Step : VOLUNTEER TEACHER Name and Signature of Employee
II CLEARANCE FROM WORK-RELATIVED ACCOUNTABILITIES
We hereby certify that this employee is cleared / not cleared of work-related accountabilities from this Unit/Office/Dept.

CARLOSIA T. AGUSTIN MYRNA S. LAURON, Ph.D

School Head PSDS/DIC
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Name of Unit/Office/Department Cleared Not Name of clearing Officer/Official Signature
Cleared
SCHOOL
1 ADMINISTRATIVE SERVICES
a. Supply and property Procurement and FELY CABUGNGAN-DEDAL
Management Services School Property Custodian
b. Human Resource Welfare & Assistance FELY CABUGNGAN-DEDAL
School Planning Officer
2 LIBRARY
b. Library Services
3 FINANCE AND ASSETS MANAGEMENT
PERLITA C. OLIVA
a. Financial Services PTA President/ Treasurer
b. Transaction, Processing & Billing Services
c. Payroll & Remittance Services
DISTRICT
1 ADMINISTRATIVE SERVICES
a. Supply and property Procurement and ALFREDO VICENTE V. LOREN
Management Services Administrative Officer II/District Property Custodian
b. Human Resource Welfare & Assistance ALFREDO VICENTE V. LOREN
Administrative Officer II/District Planning Officer
3 FINANCE AND ASSETS MANAGEMENT

a. Financial Services PPSTA Treasurer

b. Payroll & Remittance Services MAE CEL A. LISAYAN
District ADAS
DIVISION
1 ADMINISTRATIVE SERVICES
Supply and property Procurement and DANTE A. GRUMO
N/A
a. Management Services Administrative officer IV
b. Human Resource Welfare & Assistance SHIRLENE E. CRABAJALES
N/A
Administrative officer V
EPPIE P. CABRERA
N/A
C. For publication of ITEM HRMO/AO IV
Atty. JOSEPH ERIC C. LUMACTOD
N/A
d. Agency-accredited Union/Cooperative Legal Officer
2 LIBRARY
Atty. JOSEPH ERIC C. LUMACTOD
a. Legal Office Library Legal Officer
N/A
Atty. JOSEPH ERIC C. LUMACTOD
b. Library Services Legal Officer
3 FINANCE AND ASSETS MANAGEMENT
BETHANY I. EVILLA, CPA
N/A
a. Financial Services Accountant III
RPSU N/A
b. Transaction, Processing & Billing Services
c. Payroll & Remittance Services RPSU N/A
4. PROFESSIONAL & INSTITUTIONAL DEVELOPMENT
a. Scholarship Services HRTD N/A
IV CERTIFICATION OF NO PENDING ADMININSTRATIVE CASE:
Atty. JOSEPH ERIC C. LUMACTOD
N/A
a. Internal Affairs Office/Legal Affairs Office Legal Officer
 with pending administrative case
with ongoing investigation (no formal charge yet)
V CERTIFICICATION

JOSITA B. CARMEN, CESO V

Schools Division Superintendent