CS Form No.

7
Series of 2017
DEPARTMENT OF HEALTH - CENTRAL VISAYAS CENTER FOR HEALTH DEVELOPMENT
CLEARANCE FORM

I PURPOSE

Date of Application
TO: DEPARTMENT OF HEALTH - CVCHD
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: ____________________________

______________________________________
Position/SG/Step: ____________________________ 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.

_______________________________ _______________________________
Immediate Supervisor Division Head
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector
ARNULFO E. LAVARES
a. Supply Section Administrative Officer V

THERESA Q. TRAGICO
b. Human Resource Management Office Administrative Officer V

JOEL O. SAQUILON
c. Agency-accredited Cooperative (HWMPC) Administrative Officer V
2. Knowledge Management and Information Technology Service
AILYN C. LUAÑA
a. Records Section Librarian I

AILYN C. LUAÑA
b. Library Librarian I

EUGENIA MERCEDES R. CAÑAL, MD

c. Information & Communications Technology Unit Medical Officer IV
3. Finance and Assets Management
ANGIELINE T. ADLAON
b. Accounting Section Accountant III

JOSEPHINE D. VERGARA
c. Cashier Section Administrative Officer V
4. Professional and Institutional Development
MONETTE L. ZUÑIGA
a. Health Human Resource Development Unit DMO IV

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

ATTY. JO DAVID Z. BORCES
a. Legal Section Attorney III

with pending administrative case

with ongoing investigation (no formal charge yet)

V RECOMMENDING APPROVAL:

RAMIL R. ABREA, CPA, MBA

Chief Administrative Officer
APPROVED:

JAIME S. BERNADAS, MD, MGM, CESO III

_________________________________
Director IV

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