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    Clearance New Format Anino

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    Gladdy Cabreza
    This document is a clearance form from the Department of Health Center for Health Development-Caraga in the Philippines. It details the purpose, positions, and process for clearing an employee named Jeanry R. Raro of any money, property, or work-related accountabilities before their end of contract period from April 24, 2023 to July 15, 2023. The form certifies that the employee has been cleared by their supervisor and various departments within the organization, including administration, finance, and legal, and that there are no pending administrative cases against the employee.

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

    Clearance New Format Anino

    Uploaded by

    Gladdy Cabreza
    32 views2 pages
    This document is a clearance form from the Department of Health Center for Health Development-Caraga in the Philippines. It details the purpose, positions, and process for clearing an employee named Jeanry R. Raro of any money, property, or work-related accountabilities before their end of contract period from April 24, 2023 to July 15, 2023. The form certifies that the employee has been cleared by their supervisor and various departments within the organization, including administration, finance, and legal, and that there are no pending administrative cases against the employee.

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    This document is a clearance form from the Department of Health Center for Health Development-Caraga in the Philippines. It details the purpose, positions, and process for clearing an employee named Jeanry R. Raro of any money, property, or work-related accountabilities before their end of contract period from April 24, 2023 to July 15, 2023. The form certifies that the employee has been cleared by their supervisor and various departments within the organization, including administration, finance, and legal, and that there are no pending administrative cases against the employee.

    Copyright:

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

    Clearance New Format Anino

    Uploaded by

    Gladdy Cabreza
    This document is a clearance form from the Department of Health Center for Health Development-Caraga in the Philippines. It details the purpose, positions, and process for clearing an employee named Jeanry R. Raro of any money, property, or work-related accountabilities before their end of contract period from April 24, 2023 to July 15, 2023. The form certifies that the employee has been cleared by their supervisor and various departments within the organization, including administration, finance, and legal, and that there are no pending administrative cases against the employee.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    You are on page 1of 2

    Republic of the Philippines

    DEPARTMENT OF HEALTH
    CENTER FOR HEALTH DEVELOPMENT- CARAGA
    Butuan City
    CLEARANCE FORM
    (Instructions at the back)

    I PURPOSE
    17-Jul-23
    Date of Application

    TO: DEPARTMENT OF HEALTH CENTER FOR HEALTH DEVELOPMENT CARAGA


    I hereby apply for clearance from money, property and work-related accountabilities for:
    Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
    £ Retirement £ Leave Please specify: END OF CONTRACT
    Effectivity/Inclusive Peri APRIL 24, 2023 - JULY 15, 2023

    Office of Assignment: RHU PLACER


    JEANRY R. RARO
    Position/SG/Ste MRSIA ENCODER 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.

    ROMAR G. CUSTODIO, RN, MD SANDRIA C. YU, MD, MPH


    Immediate Supervisor OIC - LHS Chief/Medical Specialist IV
    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 ELEANOR B. LAKAG, MBA
    Administrative Officer V (Supply Officer)

    b. Human Resource Welfare & Assistance SUSAN M. VALENCIA, CPA, MBA


    Supervising Administrative Officer

    c. Agency-accredited Union/Cooperative ____________________________


    DOHECO Manager
    2. Library
    a. Legal Office Library Not Applicable
    b. Library Services Not Applicable
    3. Finance and Assets Management

    a. Financial Services JENALYN C. REVECHE, MMPSM


    Administrative Officer V (Cashier Designate)
    b. Transaction, Processing & Billing Services Not Applicable

    c. Payroll & Remittance Services JAY RYAN F. VILLASURDA, CPA


    Accountant III
    4. Professional and Institutional Development

    a. Scholarship Services NANCY S. JELIANGGAO, RN


    Training Specialist II

    IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

    a. Internal Affairs Office/Legal Affairs Office ATTY. SHEENA MAE B. MONTEJO


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

    V CERTIFICATION

    CESAR C. CASSION, MD, MPH, CESO III


    DIRECTOR IV

    Page 1 of 1
    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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