Division Clearance Form.xlsx

	A	B	C	D	E	F
1		Clearance Form No. 7
2		Series of 2017
3	Republic of the Philippines
4	Department of Education
5	Region VI –Western Visayas
6	SCHOOLS DIVISION OF ANTIQUE
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9	CLEARANCE FORM
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11	I	PURPOSE
12					________________________________________
13					Date of Application
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15	TO:
16		I hereby apply for clearnace from money, property and work-related accountabilities for:
17		Purpose: Transfer Resignation Other Mode of Separation:
18		Retirement Leave Please specify: _____________________
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20		Effectivity/Inclusive Period: ______________________________________________________
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23	Office of Assignment: __________________________
24					____________________________________
25		Position/SG/Step: __________________________			Name and Signature of Employee
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27	II	CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
28		We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
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30		_________________________________			________________________________________
31		Immediate Supervisor			Head of Office
32	III	CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
33	Name of Unit/Office/Department		Cleared	Not Cleared	Name of Clearing Officer/ Official	Signature
34	1.	Administration Sector
35	a.	Supply and property			MIRACLE FAITH C. SENARIO
36	a.	Supply and property			Administrative Officer IV-Supply
37	b.	Human Resource Welfare & Assistance			MIRACLE FAITH C. SENARIO
38	b.	Human Resource Welfare & Assistance			OIC Administrative Officer IV-Personnel
39	c.	Agency-accredited Union/ Cooperative
40	2.	Library
41	a.	Legal Office Library
42	b.	Library Services			MARIAN ROSE B. SARMIENTO
43	b.	Library Services			Librarian II
44	3.	Finance and Assests Management
45	a.	Financial Services			EMEROSE B. BALONDO
46	a.	Financial Services			Accountant III
47	b.	Transaction, Processing & Billing Services			GRACE S. GENOVATA
48	b.	Transaction, Processing & Billing Services			Administrative Officer IV-Cashier
49	c.	Payroll & Remittance Services			BENITO G. BACLAGON, JR.
50	c.	Payroll & Remittance Services			Administrative Officer V
51	4.	Professional and Instructional Development
52	a.	Scholarship Services
53	IV	CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
54	a.	Internal Affairs Office/Legal Affairs Office			ELIZABETH A. FELASOL
55	a.	Internal Affairs Office/Legal Affairs Office			Attorney III
56		with no pending administrative case
57		with ongoing investigation (no formal charge yet)
58	V	CERTIFICATION:
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61	NICASIO S. FRIO EdD, CESO VI
62	Officer-in-charge
63	Office of the Schools Division Superintendent
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