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Employee Exit Clearance Form PDF

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EMPLOYEE CLEARANCE FORM

Name: Employee no. Department:


Position title: Site: HO / IBA Status:
Hired date: Exit date: Date today:
Reason for leaving: [ ] Transfer/ reassignment [ ] Resignation [ ] Termination
Nature of reason: [ ] Better career opportunity [ ] Travel abroad [ ] Family concerns
[ ] Medical issues [ ] Others: ___________________________

By initialing below, I certify that I have complied with the Company Rules regarding the following items upon
separation. An employee is required to make a clearance to the respective Department before leaving the
Company. You are instructed to bring this form to the various Department as stated below to obtain Clearance
before the last salary can be released
Department Cleared / Approving Remarks
Not cleared Signature/ Date
I. Employee’s own department
a. Documents
b. Properties (Laptops, car, equipment)
c. Office key
d. Others: ___________________
II. Finance Department
a. Cash advances
b. Reimbursements
c. Loans
d. Others: ___________________
III. HRAD
a. HMO
b. Resignation letter
c. Leave balances
d. Timekeeping records
e. Unpaid salary
f. ID
g. E-mail/ Dropbox
h. Others: ___________________

___________________________________ __________________
Printed Name over Signature of Employee Date today

______________________________________________ __________________________
Complete Mailing Address Contact Number

The final paycheck and/or leave payout can be authorized for release to this employee upon the necessary approval
and receipt of the completed Exit Questionnaire and Clearance Form by the Human Resources Department.

HRAD APPROVAL

Admin Officer ___________________________________________________ Date _____/_____/_____

HRAD Manager _________________________________________________ Date _____/_____/_____

Payroll ______________________________________________________ Date _____/_____/_____

Records _____________________________________________________ Date _____/_____/_____

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