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CS Form No. 7 Clearance Form Kim
CS Form No. 7 Clearance Form Kim
DEPARTMENT OF EDUCATION
Region I
CS Form No. 7
Series of 2017
CLEARANCE FORM
(Instructions at the back)
I PURPOSE
Date of Application
TO: SDO I PANGASINAN
I hereby apply for clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: ________________
Effectivity/Inclusive Period: __________________________
1. Administration Sector
Supply and Property Procurement and MARITES L. JOSE
a. Management Services SCHOOL PROPERTY CUSTODIAN
TERESITA A. ABALOS
b. Human Resource Welfare & Assistance PRINCIPAL I
N/A
a. Legal Office Library
LIBRARIAN
b. Library Services
3. Finance and Assets Management
SALVA E. VINOYA
a. Financial Services CASHIER/SCHOOL TREASURER
SALVA E. VINOYA
c. Payroll & Remittance Services CASHIER/SCHOOL TREASURER
4. Professional and Institutional Development
a. Scholarship Services N/A
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
V CERTIFICATION
EARANCE FORM
nstructions at the back)
Date of Application
___________________________
Name and Signature of Employee
TERESITA A. ABALOS
PRINCIPAL I
Signature
ORA V. NABOR, D.A.
hools Division Superintendent
Page 1 of 2
INSTRUCTIONS:
2. This clearance should be duly accomplished before paying the last salary or
any money due the employees. (Specify which type of clearance: maternity
leave, retirement, transfer, etc.)