the person named below is requesting work experience verification from your establishment.  please assist the applicant, who is seeking michigan vocational teaching certification, by completing the information below.

1.  The individual named above worked for us from _______________  _______________  to _______________  _______________

                                                                                  month                    year                        month                    year

2.  The individual named above worked ________weeks, accumulating a total of _________hours for the entire time period.

3.  The job title of the applicant was/is: _____________________________________________________________________

4.  Please describe the job duties, tasks, or responsibilities that the applicant performed: (attach additional documents if necessary)

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

If the individual named above held more than one job title with your organization, complete an additional “Verification of WorkExperience” form.

_________________________________________________________________________        _____________   _________________

Name of Work Establishment, Organization, or Company                                                       Area Code       Telephone Number

___________________________________________________________________________________________________________

Address of Establishment                                                                         City                          State                      Zip

___________________________________________________      ____________________________________________________

Signature of Verifying Official                                                                                   Position of Verifying Official

__________________________________

NMU Use - Date form was submitted

this form must be notarized – please attach seal and signature.

the person below is submitting self-employment work experience verification from work done for you.  please assist the applicant, who is seeking michigan vocational teaching certification, by completing the information.

1.  The individual named above, worked on the project below, from ___________  ___________  to __________  _________

                                                                                                                 month               year                    month           year

2.  The individual named above worked for a total of _______________ hours to complete the project.

3.  Please describe the nature of the work, job duties, tasks, or responsibilities that the applicant performed:

                                                                                             (attach additional documentation as necessary)

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

___________________________________________   _______________________________________  ________________

1.  The individual named above, worked on the project below, from _____________  _____________  to ______________ ______________

                                                                                                       month                 year                       month               year

2.  The individual named above worked for a total of _______________ hours to complete the project.

3.  Please describe the nature of the work, job duties, tasks, or responsibilities that the applicant performed:

                                                                                             (attach additional documentation as necessary)

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_______________________________________        _______________________________________      _______________

__________________________________________________    ____________________________________________________ 

                   Signature of Self-Employed Applicant                                      Name of Business if Applicable

_______________________________

NMU Use - Date form was submitted

this form must be notarized – please attach seal and signature.