Clearance Form: Tarlac State University
Clearance Form: Tarlac State University
Clearance Form: Tarlac State University
7-A
Series of
Revised 2017
2018
TARLAC STATE UNIVERSITY
CLEARANCE FORM
(For Retirement/Separation purposes of Plantilla personnel, incl. Contractual, only)
(Instructions at the back)
I PURPOSE
Date of Filing
TO: TARLAC STATE UNIVERSITY
I hereby request clearance from money, property and work-related accountabilities for:
Purpose: Transfer Resignation Other Mode of Separation:
Retirement Please specify: __________________________
Date of Effectivity: __________________________________________________________
_______________________________ _______________________________
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
Human Resource Development & Management
a. Office
a. Library Services
3. Finance and Assets Management
a. Accounting Unit
V CERTIFICATION
Recommending Approval:
____________________________________________
Vice President (Acad./Adm./RES/PQA)
Approved:
I hereby certify that this employee is cleared of work-related, money and property accountabilities from the University.
This certification includes no pending administrative case from the University.
_________________________________
President
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INSTRUCTIONS:
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