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CS Form No. 7 Clearance Form

This document is a clearance form used by an agency to certify that an employee leaving their position has been cleared of any work-related or financial obligations. The form requires signatures from the employee's supervisor and department head to confirm they have been cleared of work duties, and signatures from officials of various agency units to verify there are no outstanding financial issues. Instructions are provided on the back explaining how and when the form should be completed depending on the reason for an employee's departure.

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Royal Marj
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72 views

CS Form No. 7 Clearance Form

This document is a clearance form used by an agency to certify that an employee leaving their position has been cleared of any work-related or financial obligations. The form requires signatures from the employee's supervisor and department head to confirm they have been cleared of work duties, and signatures from officials of various agency units to verify there are no outstanding financial issues. Instructions are provided on the back explaining how and when the form should be completed depending on the reason for an employee's departure.

Uploaded by

Royal Marj
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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CS Form No.

7
Series
Seriesofof2017
2017
Agency Name
CLEARANCE FORM
(Instructions at the back)

I PURPOSE

Date of Application
TO: LGU-BACOLOD CITY
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 Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration Sector

Supply and Property Procurement and


a. Management Services

b. Human Resource Welfare & Assistance

c. Agency-accredited Union/Cooperative
2. Library

a. Legal Office Library

b. Library Services
3. Finance and Assets Management

a. Financial Services

b. Transaction, Processing & Billing Services

c. Payroll & Remittance Services


4. Professional and Institutional Development

a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. Internal Affairs Office/Legal Affairs Office


with pending administrative case
with ongoing investigation (no formal charge yet)

V CERTIFICATION

_________________________________
Signature over Printed Name of Agency Head
Page 1 of 2
INSTRUCTIONS:

1. Employees who are retiring, being separated, transferring to other agencies,


leaving the Philippines and going on maternity leave of absence shall prepare
this form in quadruplicate.

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.)

3. If the employees are cleared from a unit/office/department, the


clearing/authorized official may attach to this clearance the pertinent
document/s that shall prove that the employees are cleared of any obligation
or accountability from their office, if any, and tick the box under the "Cleared"
column before affixing their signatures.

4. If the employees appear to have uncleared accountability/ies from a


unit/office/department, the clearing/authorized official shall attach to this
clearance the pertinent document/s that shall prove that the employees have
remaining obligation or accountability from their office further indicating the
necessary action/s that the employee must satisfy in order to be cleared, and
tick the box under the "Uncleared" column. The clearing/authorized official
must only sign this clearance corresponding to their name once the employee
have complied the necessary requirements and cleared of all the obligation/s
and accountability/ies from their office. They must also tick the box under the
"Cleared" column.

5. The HRMO shall distribute copies of approved clearance as follows: original to


the employee; duplicate to be attached to the payroll or voucher; triplicate to
human resource unit file; and fourth copy to accounting/auditing office.

6. Processing of clearance certificate shall follow the order of number indicated.


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