CS Form No.

7
Revised 2018
DEPED- DIVISION OF SURIGAO DEL SUR
CLEARANCE FORM
I PURPOSE:

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 specific:

Effectivity/Inclusive Period :

Office of Assignment :

Position/SG/Step : 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.

JOSITA B. CARMEN, CESO V

District Supervisor/Principal Schools Division Superintendent

III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES

Name of Unit/Office/Department Not

Cleared Cleared Name of clearing Officer/Official Signature

1 ADMINISTRATIVE SERVICES
Supply and property Procurement and AUDREY ROSE BRIONES
a. Management Services Administrative officer I

b. Human Resource Welfare & Assistance DHANNYVIC P. SUAREZ

Administrative assistant II
EPPIE P. CABRERA
C. For publication of ITEM NA NA HRMO/AO IV NA
Atty. JOSEPH ERIC C. LUMACTOD
d. Agency-accredited Union/Cooperative NA NA Legal Officer NA
2 LIBRARY
FLORENCE C. ALMOCERA
a. Legal Office Library District- Library and Media Center Coordinator
FLORENCE C. ALMOCERA
b. Library Services District- Library and Media Center Coordinator

3 FINANCE AND ASSETS MANAGEMENT

LEO P. EVANGELIO
a. Financial Services Administrative Assistant III
N/A
RPSU
b. Transaction, Processing & Billing Services
RPSU N/A
c. Payroll & Remittance Services

4. PROFESSIONAL & INSTITUTIONAL DEVELOPMENT

a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMININSTRATIVE CASE:
Atty. JOSEPH ERIC C. LUMACTOD
a. Internal Affairs Office/Legal Affairs Office Legal Officer
with pending administrative case
with ongoing investigation (no formal charge yet)

V CERTIFICATION

I hereby certify that this employee is cleared of work-related, money and property accountabilities from this agency. This
certification includes no pending administrative case from this agency.

JOSITA B. CARMEN, CESO V

Schools Division Superintendent