EMPLOYEE CLEARANCE FORM

Name of Employee: Position

Employee ID #: Department:

Immediate Superior: Last working Day:

Type of Separation

_Resignation
_Retirement
_End of Contract
_Dismissed of Cause
_Other (please specify)_________________________

Employee Responsibilities

I have surrendered all (check all that apply) which were entrusted to me during my employment.
Laptop Company ID Keys Tablet

Mobile Phone Manuals Cash Advance Company Uniforms

 Office Supplies

Stapler Calculator Staple Remover Notebook

 Others (please indicate) __________________________________________________________

This further certified that the information herein stated are true and correct to the best of
our knowledge.

DEPARTMENT Signature
Immediate Supervisor

HR and Admin Department

Warehouse Department

Accounting Department

President and Managing Director

REMARKS: ___________________________________________________________________________

___________________________________________________________________________

__________________________________
Employee’s Signature over Printed Name