ROUTE-TO-MARKET SALES, INC.

438 Gen. Ordoñez St., Brgy. Parang, Marikina City

Employee Clearance Form

Form to be attached
to personal record
Name of Employee Department/Unit

Employee ID Employment Date:

Supervisor Position
Job Title Position Type [Full time] [Part time] [Other]

Type of Separation
Resignation ___ Termination ___ Lay Off ___ Retirement ___
Seasonal Lay Off ___ Leave of absence ___ Probationary ___ Department Transfer ___
Institutional Transfer ___ Other ___

Contact Information
Mailing address: Present Address:
ZIP Code: Contact No.:
Separation Date:

Employee Responsibilities
I have surrendered all [Check all that apply] which were entrusted to me during my employment
Company ID Badge ___ Cell Phone ___ Vehicle Gas Card ___ Vehicle ___
Technician Tools ___ Building Keys ___ Personal Computer ___ Maintenance Tools ___
Inventorial Property ___ Laptop/Notebook ___ Computer Equipment ___ Manuals ___
Vehicle Keys ___ Other ___ Other ___ Other ___

 I have cleared all matters pertaining to petty cash funds and state expenditures. I understand that if I owe any outstanding
monies it may be withheld from my final paycheck.
 I have been informed of the terms and conditions on my resignation.

Supervisor [Check to approve]

Final Time Card Approved? ___
Employee Resignation Letter Received? ___
Notifying the following department(s) to delete the relevant information as per rules & regulations. ___
IT Department [Delete access to server] ___ HR Department [To update payroll] ___

Employee Signature [Date] Supervisor Signature [Date]

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