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Clearance Form: Atipolo Elementary School
Clearance Form: Atipolo Elementary School
Clearance Form: Atipolo Elementary School
7
Series
Seriesofof2017
2017
Agency Name
CLEARANCE FORM
(Instructions at the back)
20-May-21
Date of Application
TO: Deped-Division of Biliran
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: ___AUGUST
May 21, 20201
19-22, 2019_____________________________________
Office of Assignment: __
SAMAPAO ELEMENTARY
ATIPOLO ELEMENTARY SCHOOL
SCHOOL
HARRY L. ERRO JR
Position/SG/Step: Teacher
PRINCIPAL
III/13/
1__________
Step I Name and Signature of Employee
II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
We hereby certify that this applicant is cleared of work-related accountabilities from this Unit/Office/Dept.
c. Agency-accredited Union/Cooperative
2. Library
b. Library Services
3. Finance and Assets Management
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
V CERTIFICATION
AIDA C. CABRERA
Signature over Printed Name of Agency Head
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.)