CS Form No.

7
Series of 2017 Department of Education
SCHOOLS DIVISION OF BULACAN

CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: DepEd Pandi South District Office
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: ANNA MARIE C. ROXAS

Position/SG/Step: 11/3 TEACHER I

II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES

I hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.

ROSELLE L. DE JESUS ESPERANZA F. PEREZ, EdD

Head Teacher I 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 DAISY P. ANTONIO
a.
Management Services
/ Administrative Officer II
DAISY P. ANTONIO
b. Human Resource Welfare & Assistance /
Administrative Officer II

c. Agency-accredited Union/Cooperative NONE

2. Library
AURA A. ESPINAS
a. Legal Office Library /
Administrative Officer II
AURA A. ESPINAS
b. Library Services /
Administrative Officer II
3. Finance and Assets Management
MARIA CRISTINA M. DALISAY
a. Financial Services /
District Treasurer
REYNALDO R. SANTOS
b. Transaction, Processing & Billing Services /
Administrative Assistant III
REYNALDO R. SANTOS
c. Payroll & Remittance Services /
Administrative Assistant III
4. Professional and Institutional Development

a. Scholarship Services N/A

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office ATTY. ELMER D. LOPEZ

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

V CERTIFICATION

NORMA P. ESTEBAN, EdD, CESO V

Schools Division Superintendent
Schools Division of Bulacan