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Verification of Teaching Experience: Male Female Home Work

This document is a verification of teaching experience form. It contains sections for an applicant to provide identifying information and for an employer to verify the applicant's dates of employment, subjects taught, grade levels, and sign and date the form. The form notes that teacher certification in Missouri requires verified, contracted teaching experience of at least half-time and that substitute teaching cannot be counted. Employers are asked to return the completed, signed form directly to the applicant in a sealed envelope.

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166 views1 page

Verification of Teaching Experience: Male Female Home Work

This document is a verification of teaching experience form. It contains sections for an applicant to provide identifying information and for an employer to verify the applicant's dates of employment, subjects taught, grade levels, and sign and date the form. The form notes that teacher certification in Missouri requires verified, contracted teaching experience of at least half-time and that substitute teaching cannot be counted. Employers are asked to return the completed, signed form directly to the applicant in a sealed envelope.

Uploaded by

jmatthews
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Verification of

Teaching Experience

SECTION I: TO BE COMPLETED BY APPLICANT. APPLICANT MUST SEND THIS FORM TO ALL EMPLOYERS TO VERIFY
CONTRACTED TEACHING EXPERIENCE.
SOCIAL SECURITY NUMBER

CURRENT NAME (LAST, FIRST, MIDDLE INITIAL)

ALL MAIDEN/FORMER NAMES

STREET ADDRESS

CITY, STATE, ZIP CODE

□ □
DATE OF BIRTH PHONE NUMBERS
MALE FEMALE HOME WORK
LEGAL SIGNATURE OF APPLICANT DATE

SECTION II: TO BE COMPLETED BY EMPLOYING SCHOOL SYSTEM


The above named individual was employed as a teacher in our school system as verified below.
BEGINNING DATE OF EMPLOYMENT ENDING DATE OF EMPLOYMENT TOTAL YEARS TAUGHT

SUBJECT AREA(S) TAUGHT GRADE LEVEL(S) SUBJECT AREA(S) TAUGHT GRADE LEVEL(S)

NAME OF SCHOOL SYSTEM

SCHOOL ADDRESS

CITY, STATE, ZIP CODE

ADMINISTRATOR’S NAME (PRINT OR TYPE) ADMINISTRATOR’S TITLE SCHOOL PHONE NUMBER

ADMINISTRATOR’S SIGNATURE DATE

NOTE: Teacher certification in Missouri is designed into multi-level plan. Teachers are issued the appropriate level according to the number
of years of teaching experience and the level of education. Experience must be contracted in a recognized, accredited school and at least
half-time. Substitute teaching or serving as a teacher's aide or assistant cannot be counted.
The Department of Elementary and Secondary Education does not discriminate on the basis of race, color, religion, gender, national origin, age, or
disability in its programs and activities. Inquiries related to Department programs and to the location of services, activities, and facilities that are
accessible by persons with disabilities may be directed to the Jefferson State Office Building, Office of the General Counsel, Coordinator – Civil Rights
Compliance (Title VI/Title IX/504/ADA/Age Act), 6th Floor, 205 Jefferson Street, P.O. Box 480, Jefferson City, MO 65102-0480; telephone number 573-
526-4757 or TTY 800-735-2966 [email protected].

PLEASE RETURN THIS FORM TO THE TO THE APPLICANT IN A SEALED OFFICIAL SCHOOL ENVELOPE.
THIS FORM MAY BE DUPLICATED FOR ADDITIONAL EMPLOYERS.
ORIGINAL SIGNATURE REQUIRED-NO FAXES OR PHOTOCOPIES!
www.dese.mo.gov

Revised October 1, 2018

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