ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Series of 2017
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PAMPANGA STATE UNIVERSITY
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CLEARANCE FORM
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NON-ACADEMIC
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I
PURPOSE
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Date of Application
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TO:
Pampanga State University
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I hereby apply for 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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Effectivity/Inclusive Period:
____________________________________________________________
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Office of Assignment:
______________________________
______________________________
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Position/SG/Step:
______________________________
Name and Signature of Employee
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II
CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
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We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
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______________________________________________________________________
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 Immediate Supervisor/ Dean/Director
Head of Office/ Cluster Vice President
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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.
Administration Sector
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a. Property and Supply Management OfficeMAIR S. DE LARA,MPA, RLA
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b.Human Resource Welfare & AssistanceDEBBIE ANN FATIMA N. BARRERA, MPA
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c.Agency-accredited Union/CooperativeEDDIEBAL P. LAYCO, Ph. D.
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2.
Library
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a.
Legal Office Library
N/A
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b.
Library Services
SUZETTE B. MACASPAC
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3.
Finance and Assets Management
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a.Financial ServicesLUIS M. LANSANG, DPA
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b.Transaction, Processing & Billing ServicesJOSEPH IAN P. GUINTU, CPA, MBA
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c.Payroll & Remittance ServicesROSALIE D. SAMPANG
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4.
Professional and Institutional Development
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a.Scholarship ServicesREDEN M. HERNANDEZ, RCE, MM
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IV
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
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a.Internal Affairs Office/Legal Affairs OfficeATTY. BRYAN G. PUERTO
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with pending administrative case
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with ongoing investigation (no formal charge yet)
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VC E R T I F I C A T I O N
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ENRIQUE G. BAKING, Ed.D
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Signature over Printed Name of Agency Head
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