EMPLOYMENT CLEARANCE FORM
NAME: ______________________________ EMPLOYEE NO. _________ DESIGNATION: _____________________
ADDRESS: ____________________________ CONTACT NUMBER: ______________ COMPANY: ______________
An employee is required to return the Company’s properties to the respective Department before leaving the
service of the Company. His/her is instructed to bring this form to the various Departments as stated below to
obtain Clearance before collection of salary.
1. Employee’s Own Department/ Store
Outstanding items:
o Company Identification Card:_________________ Value: ______________ _________
o Company Uniform: _________________________ Cleared By: ____________________
o ATM Payroll: ______________________________ Date: _________________________
2. Office/ HR
Outstanding items:
o Issued equipment:____________________ Value: ______________ __________
o Cash Advance/s:______________________ Cleared By: ____________________
o Government Loans: ___________________ Date: _________________________
Through careful due diligence, final payment final payment will be made on: ______________________
Employee Signature: __________________________ Approved by: ______________________________
HUMAN RESOURCE ONLY:
● Last Pay (unpaid): ________________
● Holdback Fund: __________________
● 13th month Pay: _________________
FINAL PAY: __________________
APPROVED BY: ____________________