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Department of Education

Employee No.___________

Republic of the Philippines

DEPARTMENT OF EDUCATIONRegion IV MIMAROPA

Division of Oriental Mindoro

DISTRICT OF PINAMALAYAN EASTPinamalayan ELEMENTARY SCHOOL TEACHERS CLEARANCE

Name: _____________________________________

School: ____________________________________Grade Taught: ____________________

School Year: _________________

I hereby certify that I have complied with the following requirements on dates specified below.REQUIREMENTSNAME & SIGNATURE OF IN-CHARGEDATE SIGNED

Form 1MAYLYN S. LIMBO

Form 2REYNALDO L. PRIVADO

Form 3 & Property Inventory Report (from DepEd & from donations)REYNALDO L. PRIVADO

Form 4MAYLYN S. LIMBO

Form 5 (Report on Promotion )ESMERALDA A. GARCIA

Form 6ESMERALDA A. GARCIA

Form 7 ESMERALDA A. GARCIA

Performance Appraisal System for TeachersESMERALDA A. GARCIA

Action Research & Kinder ReportsLENIE F. FIESTADA

Year End School Clearance & Tax ClearanceESMERALDA A. GARCIA

Community Tax Cert. No.________________ Date Issued: ___________________Place Issued: ______________________________ Desired Transfer: Yes No If yes, where? _________________________________________________________________ Educational Attainment: _________________________________________________ Total Experience: ______________ Present Salary: ________________________ Status: ____________________Position: __________________________

I shall I shall not attend summer classes this summer.

Vacation Address: _________________________________________________________________________Contact No.: __________________

Date Accomplished: ________________________

____________________________

Signature of Teacher

Checked & Verified:

ESMERALDA A. GARCIAHead Teacher IIPINAMALAYAN EAST DISTRICT PINAMALAYAN

March 31,, 2015

Respectfully forwarded to the Schools Division Superintendent, Calapan City, the herein Clearance of Mr./Mrs./Miss ___________________________________ for SY 2014-2015, recommending approval.

ESMERALDA A. GARCIA

Head Teacher IIAPPROVED:

MARIA LUISA D. SERVANDO, Ph. D.

OIC-Schools Division Superintendent


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