Clearance Form

CU-QMS-NURSING-0019 Capitol University College of Nursing Cagayan de Oro City Date: _______________________ TO WHOM IT MAY CONCERN: This is to certify that Ms./Mr. ____________________________has satisfactorily complied with all requirements and settled all obligations with _________________________ from ____________________ to __________________ and is granted a clearance. ____________________________ Nurse on Duty

________________________ Clinical Instructor

Issue: 05 April 2003

Revision Code: 003

CU-QMS-NURSING-0020 Capitol University College of Nursing Cagayan de Oro City Date: _______________________ TO WHOM IT MAY CONCERN: This is to certify that Ms./Mr. ____________________________has satisfactorily complied with all requirements and settled all obligations with _________________________ from ____________________ to __________________ and is granted a clearance. ____________________________ Nurse on Duty

________________________ Clinical Instructor

Issue: 05 April 2003

Revision Code: 003

CU-QMS-NURSING-0020 Capitol University College of Nursing Cagayan de Oro City Date: _______________________ TO WHOM IT MAY CONCERN: This is to certify that Ms./Mr. ____________________________has satisfactorily complied with all requirements and settled all obligations with _________________________ from ____________________ to __________________ and is granted a clearance. ____________________________ Nurse on Duty Issue: 05 April 2006 Code: 003

________________________ Clinical Instructor Revision