VERIFICATION OF SATISFACTORY TEACHING EXPERIENCE
Polk County Public Schools, Human Resource Services
P.O. Box 391
1915 S Floral Ave
Bartow, Florida 33831
Telephone (863) 534-0781
SECTION I – COMPLETED BY APPLICANT
| | | | | | | | |
|Date | |Name | |Prior Name | |Applicant Ref. # | |
| | | |I authorize you to provide Polk County Public Schools with the following information: |
|Dates of Employment | | |Signature of Applicant _______________________________________________ |
| | | |
|VERIFICATION OF SATISFACTORY TEACHING EXPERIENCE | | |
| | | | | |
|SECTION II – COMPLETED BY FORMER EMPLOYER | | | | |
(FORMER SCHOOL SYSTEM PLEASE USE A SEPARATE LINE FOR EACH YEAR)
|SCHOOL YEAR | |DATES OF SERVICE |ACTUAL NO. OF |NO. OF DAYS IN |ACTUAL POSITION HELD |FULL TIME or |
|Year to |NAME OF SCHOOL |FROM: M/D/Y TO: M/D/Y |DAYS TAUGHT |SCHOOL YEAR |SUBJECT and/or GRADE TAUGHT |PART TIME |
|Year | | | | | | |
| | | | |
| | | |SEAL AND SIGNATURE OF NOTARY PUBLIC |
|SCHOOL ADDRESS | | | |
| | | |MY COMMISSION EXPIRES |
| | | |(MUST BE NOTARIZED OR AFFIX SCHOOL BOARD SEAL) |
|SCHOOL WEB ADDRESS | | | |
| | | | |Choose Accrediting Agency: |
|SIGN NAME | | | | |
| | | | |The Southern Association of Colleges and Schools |
| | | | |The Middle States Association of Colleges and Schools |
|PRINT NAME | | | | |
| | | | |The New England Association of Colleges and Secondary Schools |
| | | | |The North Central Association of Colleges and Secondary Schools |
|TITLE | | | | |
| | | | |The Northwest Association of Higher and Secondary Schools |
| |SUPERINTENDENT OR DESIGNEE | | |The Western Association of Colleges and Schools |
|PHONE |( ) - | | | |
| |Ext. | | | |
| | | | |Other | |
| |Please List |
-----------------------
OFFICE USE ONLY
SAP # ________________
_______yrs = ________steps
_______yrs/2 = ________steps
Approved by ______________ Date _______
................
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