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Clearance Form: Tarlac State University

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CS Form No.

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: __________________________________________________________

Office of Assignment: ____________________________


______________________________________
Name and Signature of Employee
Position/SG/Step: ____________________________
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
Not
Name of Unit/Office/Department Cleared Cleared
Name of Clearing Officer/Official Signature
1. Administration
Human Resource Development & Management
a. Office

b. Administrative Services Unit


2. Library

a. Library Services
3. Finance and Assets Management

a. Accounting Unit

b. Business Affairs & Auxiliary Services Office

c. Supply & Property Management Unit


IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:

a. HR Employee Relations Section


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

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:

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


agencies, and leaving the Philippines shall prepare this form in triplicate.
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 employee, or their representative, shall distribute copies of approved
clearance as follows: original to the central records office, human resource
office file, and employee; duplicate to be attached to the payroll or voucher;
and triplicate copy to their college/office.
6. Processing of clearance certificate shall follow the order of number indicated.

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