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 1LEONA F. FAIN

Form 2EMMA M. GUTIERREZ

Form 3 & Property Inventory Report (from DepEd & from donations)JOSEPH F. FAIN

Form 4REY D. SENORIN

Form 5 (Report on Promotion )REY D. SENORIN

Form 6REY D. SENORIN

Form 7 REY D. SENORIN

Performance Appraisal System for TeachersREY D. SENORIN

Action Research & Kinder ReportsREY D. SENORIN

Year End School Clearance & Tax ClearanceREY D. SENORIN

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:

REY D. SENORINHead Teacher IIIPINAMALAYAN 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.

REY D. SENORIN

Head Teacher III

APPROVED:

MARIA LUISA D. SERVANDO, Ph. D.

OIC-Schools Division Superintendent