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    CS Form No. 7 Revised 2018 Clearance Form

    Uploaded by

    John Ace Mata
    This document is a clearance form used by an agency to certify that an employee leaving the agency has been cleared of any work-related, financial, or property accountabilities. The form has sections for certifying clearance from work responsibilities by the employee's supervisor, clearance from money and property accounts by various agency departments, certification that there are no pending administrative cases against the employee, and final certification of full clearance by the agency head. Instructions at the end explain that the form is to be completed before an employee's final salary payment and distributed to various offices for record keeping.

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    © All Rights Reserved
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    CS Form No. 7 Revised 2018 Clearance Form

    Uploaded by

    John Ace Mata
    550 views2 pages
    This document is a clearance form used by an agency to certify that an employee leaving the agency has been cleared of any work-related, financial, or property accountabilities. The form has sections for certifying clearance from work responsibilities by the employee's supervisor, clearance from money and property accounts by various agency departments, certification that there are no pending administrative cases against the employee, and final certification of full clearance by the agency head. Instructions at the end explain that the form is to be completed before an employee's final salary payment and distributed to various offices for record keeping.

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    This document is a clearance form used by an agency to certify that an employee leaving the agency has been cleared of any work-related, financial, or property accountabilities. The form has sections for certifying clearance from work responsibilities by the employee's supervisor, clearance from money and property accounts by various agency departments, certification that there are no pending administrative cases against the employee, and final certification of full clearance by the agency head. Instructions at the end explain that the form is to be completed before an employee's final salary payment and distributed to various offices for record keeping.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    550 views2 pages

    CS Form No. 7 Revised 2018 Clearance Form

    Uploaded by

    John Ace Mata
    This document is a clearance form used by an agency to certify that an employee leaving the agency has been cleared of any work-related, financial, or property accountabilities. The form has sections for certifying clearance from work responsibilities by the employee's supervisor, clearance from money and property accounts by various agency departments, certification that there are no pending administrative cases against the employee, and final certification of full clearance by the agency head. Instructions at the end explain that the form is to be completed before an employee's final salary payment and distributed to various offices for record keeping.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 2

    CS Form No.

    7
    Revised 2018
    Agency Name
    CLEARANCE FORM
    (Instructions at the back)

    I PURPOSE

    Date of Filing
    TO: (Agency Name)
    I hereby request clearance from money, property and work-related accountabilities for:
    Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
    £ Retirement £ Leave Please specify: __________________________
    Date of Effectivity: __________________________________________________________

    Office of Assignment: ____________________________


    ______________________________________
    Position/SG/Step: ____________________________ Name and Signature of Employee
    II CLEARANCE FROM WORK-RELATED ACCOUNTABILITIES
    We hereby certify that this employee is cleared / not cleared of work-related accountabilities from this Unit/Office/Dept.

    _______________________________ _______________________________
    Immediate Supervisor Head of Office
    III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
    Name of Unit/Office/Department Cleared Not Cleared Name of Clearing Officer/Official Signature
    1. Administrative Services

    a. Supply and Property Procurement and


    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

    I hereby certify that this employee is cleared of work-related, money and property accountabilities from this agency. This
    certification includes no pending administrative case from this agency.

    _________________________________
    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 leave of absence for more than 30 days
    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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