ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Series of 2017
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DEPARTMENT OF EDUCATION
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REGION III
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DIVISION OF MABALACAT CITY
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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 Application
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TO:
DEPARTMENT OF EDUCATION - MABALACAT CITY
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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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Immediate SupervisorHead of Office
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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.Supply and Property Procurement and Management ServicesRICKY JOHN V. MANARANG ADMINISTRATIVE OFFICER IV (SUPPLY)
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b.Human Resource Welfare & AssistanceJENNIFER G. SOTTO ADMINISTRATIVE OFFICER IV (PERSONNEL AND RECORDS)
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c.Agency-accredited Union/Cooperative
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2.
Library
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a.
Legal Office Library
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b.
Library Services
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3.
Finance and Assets Management
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a.Financial ServicesJAYSON M. DE LEON ACCOUNTANT III
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b.Transaction, Processing & Billing Services
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c.Payroll & Remittance Services
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4.
Professional and Institutional Development
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a.Scholarship Services
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IV
CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
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a.Internal Affairs Office/Legal Affairs OfficeMICHAEL T. PINEDA ADMINISTRATIVE OFFICER V
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with pending administrative case
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with ongoing investigation (no formal charge yet)
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C E R T I F I C A T I O N
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MARIA CARMEN P. CUENCO, EdD, CESO V
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Schools Division Superintendent
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NOTE: Subject the provision of COA Circular No. 2 quoted hereunder:

“If later on an official or employee who has been cleared and is later discovered still accountable for cash/property, the clearance previously issued will not relieve him/her of said accountability.”
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