Scribd Logo
Upload

Welcome to Scribd!

  • 464 views

    Office of The Deputy Ombudsman For Mindanao: 4th Floor, Herrera Building, Alvares Street, Davao City

    Uploaded by

    Franz Daniel Ebron
    This document is an application for an Ombudsman clearance from the Office of the Deputy Ombudsman for Mindanao. It requests basic information from the applicant such as name, date and place of birth, addresses, civil status, employment history for both government and private offices, and whether they have been criminally or administratively charged. It notes that an updated, original/authenticated service record must be attached and the timing for filing depends on if the applicant is civilian, military, or police (3 or 6 months before retirement/resignation). Upon providing the requested information and signatures, the application will be processed.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    Office of The Deputy Ombudsman For Mindanao: 4th Floor, Herrera Building, Alvares Street, Davao City

    Uploaded by

    Franz Daniel Ebron
    464 views4 pages
    This document is an application for an Ombudsman clearance from the Office of the Deputy Ombudsman for Mindanao. It requests basic information from the applicant such as name, date and place of birth, addresses, civil status, employment history for both government and private offices, and whether they have been criminally or administratively charged. It notes that an updated, original/authenticated service record must be attached and the timing for filing depends on if the applicant is civilian, military, or police (3 or 6 months before retirement/resignation). Upon providing the requested information and signatures, the application will be processed.

    Original Description:

    word

    Original Title

    Ombudsman Clearance

    Copyright

    © © All Rights Reserved

    Available Formats

    XLS, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is an application for an Ombudsman clearance from the Office of the Deputy Ombudsman for Mindanao. It requests basic information from the applicant such as name, date and place of birth, addresses, civil status, employment history for both government and private offices, and whether they have been criminally or administratively charged. It notes that an updated, original/authenticated service record must be attached and the timing for filing depends on if the applicant is civilian, military, or police (3 or 6 months before retirement/resignation). Upon providing the requested information and signatures, the application will be processed.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    464 views4 pages

    Office of The Deputy Ombudsman For Mindanao: 4th Floor, Herrera Building, Alvares Street, Davao City

    Uploaded by

    Franz Daniel Ebron
    This document is an application for an Ombudsman clearance from the Office of the Deputy Ombudsman for Mindanao. It requests basic information from the applicant such as name, date and place of birth, addresses, civil status, employment history for both government and private offices, and whether they have been criminally or administratively charged. It notes that an updated, original/authenticated service record must be attached and the timing for filing depends on if the applicant is civilian, military, or police (3 or 6 months before retirement/resignation). Upon providing the requested information and signatures, the application will be processed.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 4

    Republic of the Philippines

    Office of the Deputy Ombudsman for Mindanao


    4th Floor, Herrera Building, Alvares Street, Davao City
    (Tel.Nos. 221-3431 to 33; Fax No. 221-39-38)

    APPLICATION FOR OMBUDSMAN CLEARANCE


    IMPORTANT : 1. Please provide all information requested. Incomplete application will not be
    processed or will be returned to the applicant.
    2. ATTACH UPDATED, ORIGINAL/AUTHENTICATED SERVICE RECORD
    3. File not earlier than three (03) months for civilian employees and six (06)
    months for AFP/PNP/BJMP/BFP before retirement/resignation date.
    4. No Fee Required.
    SIR :
    I respectfullty request your good office to isue a clearance in my favor :
    (Please indicate your purpose by checking ( / ) the appropriate box )
    Retirement/Resignation
    Promotion

    Effective date : ______________________________


    Month / Day / Year
    Appointment

    Transfer

    Schooling/Scholarship

    NBI Clearance

    Loan/Bidding

    PRC License

    Service Awards

    CESB / CESO

    Change of Name

    Travel

    Employment

    Your kind consideration on this matter will be greatly appreciated.


    Very truly yours,

    FIRST NAME

    MIDDLE NAME

    LAST NAME

    HOME ADDRESS : ______________________________________________________________________


    NAME OF OFFICE OR COMPANY : ______________________________________________________
    POSITION / ITEM : _____________________________________________________________________
    ADDRESS : ___________________________________________________________________________

    Signature
    Tel./ Cell Phone No._____________
    --------------------------------------------------------------------------FOR OMBUDSMAN USE ONLY :
    REMARKS : ______________________________________________________________________________
    VERIFIED : __________________________________________ DATE : ___________________________

    INFORMATION SHEET
    1. NAME OF APPLICANT :

    _____________________________________________________________________
    FIRST NAME
    MIDDLE NAME
    LAST NAME

    2. DATE OF BIRTH : ______________________________ 3. PLACE OF BIRTH : __________________________


    4.. PROVINCIAL ADDRESS :_______________________________________________________________________
    5. CITY ADDRESS :_______________________________________________________________________________
    6. (A) CIVIL STATUS___________

    6.(B) SEX ________ 7.NAME OF SPOUSE___________________________

    8. HISTORY OF EMPLOYMENT :
    8.(A) GOVERNMENT OFFICE
    NAME OF OFFICE

    POSITION

    INCLUSIVE
    DATE

    CAUSE OF
    SEPARATION

    1.________________________ ______________________ _____________________ __________________


    2. _______________________ ______________________ _____________________ __________________
    3. _______________________ ______________________ _____________________ __________________
    9.(B) PRIVATE OFFICE
    NAME OF OFFICE

    POSITION

    INCLUSIVE
    DATE

    CAUSE OF
    SEPARATION

    1.________________________ ______________________ _____________________ __________________


    2. _______________________ ______________________ _____________________ __________________
    3. _______________________ ______________________ _____________________ __________________
    10. Have you been criminally or administratively charged before any court or administrative

    body? _____________ If so state the :


    CASE NO. ____________________ and RESULT ____________________________________________
    I DECLARE UNDER THE PENALTIES OF PERJURY THAT THE ANSWERS GIVEN ABOVE ARE
    TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

    _________________________
    DATE ACCOMPLISHED

    ____________________________________________
    SIGNATURE

    _____________________________________________________

    RESULT ____________________________________________

    You might also like