Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
City Schools Division of Dasmarias
District V of Dasmarias

VICTORIA REYES
ELEMENTARY SCHOOL

creatin
Clearance and MOV Checklist
gYearEnd Teachers
School Year 2015-2016
chances
Brgy. Victoria Reyes, City of Dasmarias
Tel. Nos.: 856-4354 Email Address: victoriareyes_es@yahoo.com

Note: This Clearance/MOV Checklist shall not be used as means to deny any teacher/employee of salary and
other benefits. Its purpose is for the settlement of obligations, responsibilities, and accountability.

The Principal
Sir:
This is to inform you

that I have satisfactorily

settled all the property and financial

obligations in the school and that I have submitted all the required reports as listed below.
May I then be granted the Year End Clearance for School Year 2015-2016.

________________________
(Signature Over printed name)
1. School Form 1 School Register
2. School Form 2 Daily Attendance of Learners
3. Duly Signed Grading Sheets
4. School Form 5 (Report on Promotion & Level of Proficiency)
5. DepEd Form 137
6. DepEd Form 138
7. Return of Unissued Cards
8. CS Form 48 (DTR)
9. Guidance Form
10. Updated Form 212 (PDS)
11. Lesson Plans/DLL
12. Test Notebook/s
13. Nutritional Status (Feeding Teacher)
14. Class Organizational List (Grade Level Chairman)
15. List of Retained/Drop-out/Transferred In and Out/Failures
16. List of Students with General Average
17. Income Tax Return (ITR)
18. Library
a. Borrowed Books
b. Borrowed Materials
19. Classroom Inventory and Room Safety
a. Room keys
b. Books
c. Equipment
d. Furniture
20. X-ray & Urine and ECG Exam or others if applicable
21. Dental Result
22. Financial Obligations
a. Teachers Club Dues
b. Canteen Funds
23. IPCRF and MOVs
24. SALN as of December 2015

25. Latest Instructional Materials Prepared (Lists and Pictures)

26. Accomplishment Reports (if applicable)
27. Comparative Analysis of Raw Scores
29. Homeroom PTA Accomplishment Reports, Minutes of Meetings, & Financial Report
In the exigency of service, I am willing to report to work and attend Summer INSET for
Teachers.
_________________________
Present Home Address
_________________________
Telephone /Cell Phone Numbers

_________________________________
Printed Name and Signature of Teacher
Date Submitted:_______________
Signed:
SALVADOR D. ODONZO JR.
Property Custodian
PASCUALITA R. DELIGERO
Canteen Manager
MYRA M. TABUZO
Teachers Club Treasurer
MARY JOY V. OLICIA
Clinic Teacher
LUCIA F. PADERNOS
Guidance Teacher
Approved and clearance granted:
FRANCIS KENNETH D. HERNANDEZ, CAR-Ph.D
Principal 1

CHECKLIST OF IMPORTANT DOCUMENTS

Note: This Clearance/MOV Checklist shall not be used as means to deny any teacher/employee of salary and
other benefits. Its purpose is for the settlement of obligations, responsibilities, and accountability.
Name of Teacher: ________________________
Indicate the dates of compliance.
_______School Form 1 School Register
_______School Form 2 Daily Attendance of Learners
_______Grading Sheets

Grade Level ;_____________

_______School Form 5(Report on Promotion & Level of Proficiency)

_______DepEd Form 137
_______DepEd Form 138
_______Return of Unissued Cards
_______CS Form 48
_______Guidance Form
_______Updated Form 212(PDS)
_______Lesson Plans/DLL
_______Test Notebook/s
_______Nutritional Status (Feeding Teacher)
_______Class Organizational List (Grade Level Chairman)
_______List of Retained/Drop-out/Transferred In and Out/Failures
_______List of Students with General Average
_______Income Tax Return (ITR)
_______Library
______Borrowed Books
______Borrowed Materials
______Classroom Inventory and Room Safety
_____Room keys
_____Books
_____Equipment
_____Furniture
______X-ray & Urine ECG Exam
______Dental Result
______Financial Obligations
______Teachers Club Dues
______Canteen Funds
______IPCRF and MOVs
______SALN as of December 2015
______ Latest Instructional Materials Prepared (Lists and Pictures)
______Accomplishment Reports (if applicable)
______ Comparative Analysis
______ Homeroom PTA Accomplishment Reports, Minutes of Meetings, & Financial Report
CHECKED BY:
______________________________
(Signature over printed name)
Date: _________________________