ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Series of 2017
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Agency Name
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CLEARANCE FORM
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(Instructions at the back)
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PURPOSE
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Date of Filing
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TO:
Department of Education - Division of iligan City
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I hereby request clearance from money, property and work-related accountabilities for:
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Purpose:
£ Transfer
£ Resignation
£ Other Mode of Separation:
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£ Retirement
 £ Leave
Please specify: __________________________
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Date of Effectivity: __________________________________________________________
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Office of Assignment: ____________________________
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______________________________________
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Position/SG/Step: ____________________________
Name and Signature of Employee
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CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
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We hereby certify that this employee is cleared / not cleared of work-related accountabilities from this Unit/Office/Dept.
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_______________________
ROY ANGELO E. GAZO
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Immediate Supervisor School Division Superintendent
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III
CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
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Name of Unit/Office/DepartmentClearedNot ClearedName of Clearing Officer/OfficialSignature
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1.
Administrative Services
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a.Supply and Property Procurement and Management ServicesHASMEN R. MALOLOY-ON ADMINISTRATIVE OFFICER IV
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b.Human Resource Welfare & AssistanceAZOR B. QUIJANO ADMINISTRATIVE OFFICER IV
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c.Agency-accredited Union/CooperativeOMAR Q. HUSSIEN DEPED NEU - ILIGAN CITY CHAPTER PRESIDENT
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2.
Library
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a.
Legal Office Library
N/AN/AN/AN/A
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b.
Library Services
CHARLOTTE D. QUIDLAT LIBRARIAN II
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3.
Finance and Assets Management
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a.Financial ServicesJOHN ANTHONY C. BALOS ACCOUNTANT III
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b.Transaction, Processing & Billing ServicesN/AN/AN/AN/A
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c.Payroll & Remittance ServicesN/AN/AN/AN/A
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4.
Professional and Institutional Development
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a.Scholarship Services RUTH C. SABAC DIVISION HRTD SEPS
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IV
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
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a.Internal Affairs Office/Legal Affairs OfficeATTY.REY B. ROMEROSA LEGAL OFFICER
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with no pending administrative case
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with ongoing investigation (no formal charge yet)
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V
C E R T I F I C A T I O N
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I hereby certify that this employee is cleared of work-related, money and property accountabilities from this agency. This certification includes no pending administrative case from this agency.
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ROY ANGELO E. GAZO
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Office of the School Division Superintendent
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