School Clearance Form 1

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CS Form No.

7 DEPARTMENT OF EDUCATION
Series of 2017 LEYTE DIVISION OFFICE
SCHOOL CLEARANCE FORM
(Instructions at the back)

I PURPOSE Maternity Leave

December
November11, 2023
3, 2020
TO: DEPARTMENT OF EDUCATION Date of Application
(Name of Agency)
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £PLeave Please specify: __________________________
Effectivity/Inclusive Period: __________________________________________________________

Office of Assignment Barugo National High School


DAINA P. GARSAIN
Position/SG/St Teacher I/SG-11/Step 1 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.

JENNYLIND C. UYSON MACARIO B. MESIAS


Filipino Department Head School 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

Supply and Property Procurement and JEANETTE E. QUILAQUIL


P Property Custodian
a. Management Services

b. Human Resource Welfare & Assistance

c. Agency-accredited Union/Cooperative
2. Library

a. Legal Office Library


DAINA P. GARSAIN
P Library in-charge
b. Library Services
3. Finance and Assets Management
KIMVERLY RUSS A. ACOL
P Senior Bookkeeper
a. Financial Services

b. Transaction, Processing & Billing Services

c. Payroll & Remittance Services


4. Professional and Institutional Development

a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office


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

V CERTIFICATION

MARIZA S. MAGAN EdD, CESO V


Schools Division Superintendent
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INSTRUCTIONS:

1. Employees who are retiring, being separated, transferring to other agencies,


leaving the Philippines and going on maternity leave of absence shall prepare
this form in quadruplicate.

2. This clearance should be duly accomplished before paying the last salary or
any money due the employees. (Specify which type of clearance: maternity
leave, retirement, transfer, etc.)

3. If the employees are cleared from a unit/office/department, the


clearing/authorized official may attach to this clearance the pertinent
document/s that shall prove that the employees are cleared of any obligation
or accountability from their office, if any, and tick the box under the "Cleared"
column before affixing their signatures.

4. If the employees appear to have uncleared accountability/ies from a


unit/office/department, the clearing/authorized official shall attach to this
clearance the pertinent document/s that shall prove that the employees have
remaining obligation or accountability from their office further indicating the
necessary action/s that the employee must satisfy in order to be cleared, and
tick the box under the "Uncleared" column. The clearing/authorized official
must only sign this clearance corresponding to their name once the employee
have complied the necessary requirements and cleared of all the obligation/s
and accountability/ies from their office. They must also tick the box under the
"Cleared" column.

5. The HRMO shall distribute copies of approved clearance as follows: original to


the employee; duplicate to be attached to the payroll or voucher; triplicate to
human resource unit file; and fourth copy to accounting/auditing office.

6. Processing of clearance certificate shall follow the order of number indicated.

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CS Form No. 7 DEPARTMENT OF EDUCATION
Series of 2017 LEYTE DIVISION OFFICE
SCHOOL CLEARANCE FORM
(Instructions at the back)

I PURPOSE Transfer of Station

July 12, 2021


November 3, 2020
TO: DEPARTMENT OF EDUCATION Date of Application
(Name of Agency)
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 Barugo National High School


PAULINE D. SALAZAR
Position/SG/St ADAS II/SG-8/Step 2 Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
I hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.

EVANGELINE C. MERCADO
School 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

Supply and Property Procurement and


JEANETTE E. QUILAQUIL
Property Custodian
a. Management Services

b. Human Resource Welfare & Assistance

c. Agency-accredited Union/Cooperative
2. Library

a. Legal Office Library


CARINA L. QUIDLAT
Library in-charge
b. Library Services
3. Finance and Assets Management
KIMVERLY RUSS A. ACOL
Senior Bookkeeper
a. Financial Services
AIMEE A. FIGURO
Disbursing Officer
b. Transaction, Processing & Billing Services

c. Payroll & Remittance Services


4. Professional and Institutional Development

a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office


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

V CERTIFICATION

MANUEL P. ALBAŇO, PhD, CESO V


Schools Division Superintendent
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