CS Form No.

7
Series of 2018

Republic of the Philippines

Department of Education
Region VII - Central Visayas
SCHOOLS DIVISION OF MANDAUE CITY

CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: Department of Education
Mandaue City Division
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: ____________________________________________________________

Office of Assignment: ____________________________

Position/SG/Step: ____________________________ 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.

Immediate Supervisor District Supervisor

III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES

Not Name of Clearing
Name of Unit/Office/Department Cleared Cleared Officer/Official
Signature

1. Administrative Services
Supply and Property Procurement and BRYAN R. SAMSON
a. Management Services Administrative Officer IV

EDGAR C. ESPINA, JR. DevEdD

b. Human Resource Welfare & Assistance Administrative Officer V

2. Finance
NELLISSA N. BATUCAN
a. Provident Loan and Cash Advance Accountant III

IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

ATTY. MARINEL D. ORO
a. Internal Affairs Office/Legal Affairs Office Attorney III
with pending administrative case
with ongoing investigation (no formal charge yet)

V CERTIFICATION

I hereby certify that ________________________________, is cleared of work-related, money and property

accountabilities. This certification includes no pending administrative case from this agency.

NIMFA D. BONGO EdD, CESO V

Schools Division Superintendent

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