Scribd Logo
Upload

Welcome to Scribd!

  • 6K views

    Application For Ombudsman Clearance

    Uploaded by

    Ce Jey
    This document is an application form for Ombudsman clearance. It lists the requirements and processing fees for different purposes of clearance, including retirement, resignation, employment, and more. It requests applicant information like name, position, agency, addresses, contact details, education history, and employment history. The form must be accomplished and submitted along with the necessary documents and payment of fees to apply for an Ombudsman clearance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application For Ombudsman Clearance

    Uploaded by

    Ce Jey
    6K views2 pages
    This document is an application form for Ombudsman clearance. It lists the requirements and processing fees for different purposes of clearance, including retirement, resignation, employment, and more. It requests applicant information like name, position, agency, addresses, contact details, education history, and employment history. The form must be accomplished and submitted along with the necessary documents and payment of fees to apply for an Ombudsman clearance.

    Original Description:

    form

    Original Title

    Application for Ombudsman Clearance

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an application form for Ombudsman clearance. It lists the requirements and processing fees for different purposes of clearance, including retirement, resignation, employment, and more. It requests applicant information like name, position, agency, addresses, contact details, education history, and employment history. The form must be accomplished and submitted along with the necessary documents and payment of fees to apply for an Ombudsman clearance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    6K views2 pages

    Application For Ombudsman Clearance

    Uploaded by

    Ce Jey
    This document is an application form for Ombudsman clearance. It lists the requirements and processing fees for different purposes of clearance, including retirement, resignation, employment, and more. It requests applicant information like name, position, agency, addresses, contact details, education history, and employment history. The form must be accomplished and submitted along with the necessary documents and payment of fees to apply for an Ombudsman clearance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Page 1 of 2

    Application for Ombudsman Clearance Form (Revised as of July 25, 2014)

    Republic of he Philippines

    Office of the Ombudsman


    Agham Road, Diliman, Quezon City 1104

    REQUIREMENTS:

    1. Duly Accomplished Application Form and ID


    2. Certified copy of service record for Retirement/Resignation purposes
    3. Certified copy of service record and Death Certificate for Death Claim purposes
    4. Payment of Processing fee

    APPLICATION FOR OMBUDSMAN CLEARANCE


    PURPOSE OF CLEARANCE : Please indicate your purpose by checking the appropriate box.

    Processing Fee P100.00


    Retirement

    Processing Fee P200.00

    (Specify Date)

    Resignation

    Foreign Travel

    (Specify Date)

    Study Grant/Scholarship

    Death Claim

    Recognition/Awards

    Rationalization

    Leave Application
    Loan Application

    Processing Fee P150.00


    Employment
    Promotion
    Transfer

    Change of Name (Specify Name)


    Requirement by JBC, CSC, CESB, Office of the President, PRC,
    GOCC, DFA, DOLE, BI, LTO, NBI, PNP & other agencies
    Please specify agency

    Confirmation
    Discharge
    Foreign Assignment

    Appointment

    Grant of Benefits, unrelated


    to the preceding purpose

    Other Purpose, please specify:

    Processing Fee P500.00


    Permit to Carry Firearms

    Processing Fee P1,000.00


    Firearm License

    Bidding Requirements

    Fidelity Bond

    MODE OF PAYMENT: Please check one


    cash

    Landbank

    MODE OF RELEASE :

    SM, Hypermart, Savemore

    Postal Money Order payable to the "Office of the Ombudsman Clearance Fees"

    LEAVE BLANK IF PAID THRU SM

    pick-up at OMB Office


    personally
    authorized representative

    regular mail

    pre-paid private courier*

    office address

    * applicant shall provide prepaid envelope


    except if paid thru SM

    present address

    APPLICANT'S INFORMATION: (Please PRINT legibly. Write "N/A" if not applicable)


    1. Name of Applicant:
    First Name

    2. Last Position Held:

    Middle Name

    Last Name

    3. If Married, Mother's Maiden Surname:

    4. Name of Agency/Office
    Address:

    5. Present Address:

    6. Previous Address

    7. Date of Birth:

    8. Civil Status:

    9. Sex:

    mm/dd/yyyy

    10. Date of Marriage:

    11. Contact Nos.:


    mm/dd/yyyy

    12. Highest Educational Attainment

    Educational
    Attainment

    Period Attended

    High School
    College
    Tel Nos.: Central Office (02) 479-7309 & (02) 926-8786; OMB-Visayas (032)412-5339; OMB-Mindanao (082) 221-3431

    Educational
    Attainment

    Period Attended

    Vocational
    Post Graduate
    Website: www.ombudsman.gov.ph; Email: [email protected]

    Page 2 of 2

    Application for Ombudsman Clearance Form (Revised as of July 25, 2014)

    13. E M P L O Y M E N T H I S T O R Y
    (To be accomplished only if service record is not attached. Use additional sheet if necessary.)
    GOVERNMENT HISTORY
    NAME OF OFFICE

    ADDRESS
    (City/Municipality, Province)

    POSITION

    INCLUSIVE DATES

    ADDRESS
    (City/Municipality, Province)

    POSITION

    INCLUSIVE DATES

    a.

    b.

    c.

    d.

    e.

    f.

    g.

    h.

    i.

    PRIVATE SECTOR
    NAME OF OFFICE
    a.

    b.

    c.

    d.

    e.

    f.

    g.

    h.

    i.

    I declare that the answers given above are true and correct to the best of my knowledge and belief.
    Printed Name of Applicant/
    Authorized Representative :

    Date Accomplished :

    Signature of Applicant/
    Authorized Representative :
    Name of Requester in
    Case of Death Claim:

    Relation to the Deceased:

    N.B. For retirement purposes, an application shall be processed not earlier than six (6) months before the date of retirement.

    You might also like