ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
Series of 2017
3
DIVISION OF SAGAY CITY
4
CLEARANCE FORM
5
(Instructions at the back)
6
I.PURPOSE:
7
8
9
Date of Application
10
TO:
DIVISION OF SAGAY CITY
11
I hereby apply for clearance from money, property and work-related accountabilities for:
12
Purpose:
£ Transfer
£ Resignation
13
£ Retirement
 £ Leave
Please specify: __________________________
14
Effectivity/Inclusive Period: __________________________________________________________
15
16
Office of Assignment: ____________________________
17
18
Position/SG/Step:
Name and Signature of Employee
19
20
II.
CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
21
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
22
____________________________________________________________________
23
Immediate SupervisorHead of Office
24
III.
CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
25
Name of Unit/Office/DepartmentClearedNot ClearedName of Clearing Officer/OfficialSignature
26
1.
Administration Sector
27
a.Supply and Property Procurement and Management Services
28
b.Human Resource Welfare & Assistance
29
c.Agency-accredited Union/Cooperative
30
2.
Library
31
a.
Legal Office Library
32
a.
Library Services
33
3.
Finance and Assets Management
34
a.Financial Services
35
b.Transaction, Processing & Billing Services
36
c.Payroll & Remittance Services
37
d.Documents Inventory
38
4.
Professional and Institutional Development
39
a.Scholarship Services
40
IV.
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
41
a.Internal Affairs Office/Legal Affairs Office
42
with pending administrative case
43
with ongoing investigation (no formal charge yet)
44
45
V.
C E R T I F I C A T I O N
46
48
MARSETTE D. SABBALUCA, CESO VI
 Schools Division Superintendent
49
Signature over Printed Name of Agency Head
50
51
52
53
54
55
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
101