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    DOH EV CHD Clearance Form

    Uploaded by

    Patrick Lloyd Merino Jackson
    This document is a clearance form used by the Department of Health - Eastern Visayas for employees who are transferring, resigning, retiring or separating from their position. The form requires the employee to provide their purpose for clearance and inclusive dates. Their immediate supervisor and head of office must then certify that the employee has been cleared of all work-related accountabilities. Various departments within the organization including administration, finance, legal and human resources must then indicate whether the employee has been cleared of any obligations or accountabilities. The form is signed by the director to provide final certification. Instructions are included on the back to describe the clearance process.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    DOH EV CHD Clearance Form

    Uploaded by

    Patrick Lloyd Merino Jackson
    296 views6 pages
    This document is a clearance form used by the Department of Health - Eastern Visayas for employees who are transferring, resigning, retiring or separating from their position. The form requires the employee to provide their purpose for clearance and inclusive dates. Their immediate supervisor and head of office must then certify that the employee has been cleared of all work-related accountabilities. Various departments within the organization including administration, finance, legal and human resources must then indicate whether the employee has been cleared of any obligations or accountabilities. The form is signed by the director to provide final certification. Instructions are included on the back to describe the clearance process.

    Original Description:

    Doh ev Clerance form

    Original Title

    DOH-EV-CHD-Clearance-Form

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    This document is a clearance form used by the Department of Health - Eastern Visayas for employees who are transferring, resigning, retiring or separating from their position. The form requires the employee to provide their purpose for clearance and inclusive dates. Their immediate supervisor and head of office must then certify that the employee has been cleared of all work-related accountabilities. Various departments within the organization including administration, finance, legal and human resources must then indicate whether the employee has been cleared of any obligations or accountabilities. The form is signed by the director to provide final certification. Instructions are included on the back to describe the clearance process.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    296 views6 pages

    DOH EV CHD Clearance Form

    Uploaded by

    Patrick Lloyd Merino Jackson
    This document is a clearance form used by the Department of Health - Eastern Visayas for employees who are transferring, resigning, retiring or separating from their position. The form requires the employee to provide their purpose for clearance and inclusive dates. Their immediate supervisor and head of office must then certify that the employee has been cleared of all work-related accountabilities. Various departments within the organization including administration, finance, legal and human resources must then indicate whether the employee has been cleared of any obligations or accountabilities. The form is signed by the director to provide final certification. Instructions are included on the back to describe the clearance process.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    You are on page 1of 6

    CS Form No.

    7
    Series of 2017
    DEPARTMENT OF HEALTH-EASTERN VISAYAS
    CENTER FOR HEALTH DEVELOPMENT
    CLEARANCE FORM
    (Instructions at the back)

    I PURPOSE

    Date of Application
    TO: DEPARTMENT OF HEALTH-EASTERN VISAYAS CENTER FOR HEALTH DEVELOPMENT
    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

    1. Administration Sector
    MARLO L. CALUMPIANO
    Supply and Property Procurement and Administrative Officer V
    a. Management Services Head, Materials Management Section

    IMELDA Q. CREER
    Administrative Officer V
    b. Human Resource Welfare & Assistance Head, Human Resource Mgt. Unit

    CARLO G. NARTEA, MD, MPH


    DMO V/DOH-RFO 8 Emloyees Asso.
    President
    (Not applicable for EVRMC & Job
    c. Agency-accredited Union/Cooperative Order/Contract of Service personnel)
    2. Library

    N/A
    a. Legal Office Library
    RONEL Y. CHUCA
    Librarian I
    b. Library Services
    3. Finance and Assets Management

    RENE V. YANSON, CPA, LLB


    a. Financial Services Supervising Administrative Officer

    DARBY A. LUMBRES, CPA, MM


    Accountant III
    b. Transaction, Processing & Billing Services Head, Accounting Section
    CARMELITA D. SUAN
    Administrative Officer V
    c. Payroll & Remittance Services Head, Cashier Section
    4. Professional and Institutional Development
    DAISY R. GORGONIA
    Training Specialist III
    a. Scholarship Services Head, HRDU
    IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
    ATTY. MARIA OLIVIA ANA R. ATILLO
    a. Internal Affairs Office/Legal Affairs Office Attorney III

    with pending administrative case


    with ongoing investigation (no formal charge yet)

    V CERTIFICATION

    MINERVA P. MOLON, MD, MPH, FPPA, CESO III


    Director IV

    Signature over Printed Name of Agency Head


    F HEALTH-EASTERN VISAYAS
    OR HEALTH DEVELOPMENT
    ARANCE FORM
    nstructions at the back)

    Date of Application

    Please specify: __________________________


    _______________________________________________

    ______________________________________
    Name and Signature of Employee

    of work-related accountabilities from this Unit/Office/Dept.

    _______________________________
    Head of Office

    Signature
    OLON, MD, MPH, FPPA, CESO III
    Director IV

    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.


    Page 2 of 2

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