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Employee Clearance Form

This document is a clearance certificate used by Worx Group of Companies to document an employee's separation from the company. It records the employee's name, position, hire and separation dates, address, reason for leaving, and requires signatures from department heads to confirm the employee has no outstanding accountabilities or liabilities. Once signed by all relevant parties, the form allows HR to process the final pay and release papers for the departing employee.

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Choy Bermillo
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900 views1 page

Employee Clearance Form

This document is a clearance certificate used by Worx Group of Companies to document an employee's separation from the company. It records the employee's name, position, hire and separation dates, address, reason for leaving, and requires signatures from department heads to confirm the employee has no outstanding accountabilities or liabilities. Once signed by all relevant parties, the form allows HR to process the final pay and release papers for the departing employee.

Uploaded by

Choy Bermillo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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WORX GROUP OF COMPANIES

CLEARANCE CERTIFICATE
Name: Date:
Position: Department & Area of Assignment:

Date Hired: Effective Date of Separation: Last working Day:


Present Address:
Provincial Address: Contact #:
Reason for Clearance: (Please Check)

RESIGNATION CONTRACT/PROJECT COMPLETION RETRENCHMENT

TERMINATION OTHERS (SPECIFY)______________________________________________________________


Instruction:
1) All clearing officers should indicate on this form all the employee’s accountabilities in your department. It is necessary
to indicate his/her accountabilities otherwise you will be held responsible for any account not reported on this form.
2) Kindly indicate your signature on the space provided only if the employee has no accountability in your department
3) Please do not delay the routing of this form in order to expedite the processing of separation documents and release
papers.
REFERENCES NATURE OF CLEARING OFFICER NAME & DATE
ACCOUNTABILITY SIGNATURE
DEPARTMENT
HEAD
SALES/RETAIL
OPERATIONS
GENERAL SERVICES
DEPARTMENT
RMA
DEPARTMENT
LOGISTICS
DEPARTMENT
MARKETING
DEPARTMENT
PRODUCT SPECIALIST
DEPARTMENT
PURCHASING
DEPARTMENT
WAREHOUSE
DEPARTMENT
MIS
DEPARTMENT
WEB/PROGRAMMING
DEPARTMENT
TRAINING
DEPARTMENT
HR OPERATIONS
DEPARTMENT
BRANCH
ACCOUNTING
C&C
DEPARTMENT
FINANCE
DEPARTMENT
AUDIT
DEPARTMENT
LEGAL
DEPARTMENT

I hereby authorize the company to deduct the above liabilities/amount from my accrued salary/ Allowance.

_________________________
Employee’s Signature over Printed Name

FOR HR OPERATIONS USE ONLY

Timekeeping Prepared by:


No. of days Absent= ______________________ ______________________________________________
No.of min, Tardy =______________________
No. of hours UT =______________________
Expected Date of Release of Final Pay:
No.of hours OT =______________________
________________________________________________
No. of Holidays =______________________
No. of Leaves =______________________

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