ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Republic of the Philippines
2
Department of Education
3
National Capital Region
4
SCHOOLS DIVISION OF PARAÑAQUE CITY
5
Kabihasnan St., Barangay San Dionisio, Parañaqie City
6
Agency Name
7
CLEARANCE FORM
8
(Instructions at the back)
9
I
PURPOSE
10
11
12
Date of Application
13
TO:
DEPARTMENT OF EDUCATION - DIVISION OF PARAÑAQUE CITY
14
I hereby apply for clearance from money, property and work-related accountabilities for:
15
Purpose:
£ Transfer
£ Resignation
£ Other Mode of Separation:
16
£ Retirement
 £ Leave
Please specify: __________________________
PERSONAL LEAVE
17
Effectivity/Inclusive Period: __________________________________________________________
18
19
Office of Assignment: ____________________________
PES UNIT 2
MILDRED B. SARMIENTO
20
21
Position/SG/Step: ____________________________
TEACHER 2 STEP 5
Name and Signature of Employee
22
23
II
CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
24
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
25
NEMESIO B. BUNNAO, PhD
26
School Principal
27
III
CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
28
Name of Unit/Office/DepartmentClearedNot ClearedName of Clearing Officer/OfficialSignature
29
1.
Administration Sector
30
a.Supply and Property Procurement and Management ServicesVICENTE B. PELAYO Admin. Officer IV-Supply
31
b.Human Resource Welfare & AssistanceSHERYL R. CASTILLO Admin. Officer IV-HR
32
c.Administrative / General ServicesSALVE D. TESORERO Admin. Officer V
33
2.
Library
34
a.
Library Services
KATREENA A. BALUYOT Librarian II
35
3.
Finance and Assets Management
36
a.Financial ServicesSHIRLEY S. TRINIDAD Accountant III
37
b.Transaction, Processing & Billing ServicesIVY DYAN B. CAPILI Admin. Officer IV-CASH
38
c.Payroll & Remittance ServicesMARILOU J. CUSI Supervising Administrative Officer (N.C.R.)
39
4.
Professional and Institutional Development
40
a.Scholarship ServicesLEAH E. SUDSAKORN Senior Education Program Specialist - HRD
41
IV
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
42
a.Internal Affairs Office/Legal Affairs OfficeMARK FRANCIS O. NA-OY Attorney III
43
with pending administrative case
44
with ongoing investigation (no formal charge yet)
45
46
V
C E R T I F I C A T I O N
47
48
For:
 NERISSA L. LOSARIA, CESO V
49
Schools Division Superintendent
50
51
52
By:
VIOLETA M. GONZALES, CESO VI
53
Assistant School Division Superintendent
54
55
Page 1 of 2
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100