MIAMI-DADE COUNTY PUBLIC SCHOOLS TEACHING …

MIAMI-DADE COUNTY PUBLIC SCHOOLS TEACHING EXPERIENCE VERIFICATION

M-DCPS Employee # (if known)

CANDIDATE: COMPLETE THIS SECTION AND SEND TO EACH EMPLOYER FROM WHOM YOU ARE REQUESTING EXPERIENCE.

(Name of Former School/Institution) (Address)

(City)

(State/Country)

(Zip Code)

RETURN ORIGINALS (NO COPIES/FAXES)

TO : MIAMI-DADE COUNTY PUBLIC SCHOOLS

Compensation Administration 1450 NE 2nd Ave., Suite 621 Miami, FL 33132

EMPLOYEE NAME: ____________________________________________, SSN _______________________, has been employed by Miami-Dade County Public Schools, Miami, Florida.

Anticipated assignment with Miami-Dade County Public Schools (e.g., Fifth Grade Teacher, Language Arts Teacher,

Science Teacher, etc.):

.

TO BE COMPLETED ONLY BY FORMER EMPLOYER: Verification of teaching experience is required for state and county salary purposes.

Please check if employee has retired from your school district:

Yes No Year Retired:

INSTRUCTIONS: Please complete this form as accurately as possible in accordance with your personnel or payroll records, using one line for each year. (For questions please e-mail us at compensation@ or call (305) 995-7040).

Name & Address of School District or Institution of Higher Learning: (If Different From Above)

FULL-TIME TEACHER (PRE-K THROUGH 12, COLLEGES, UNIVERSITIES)

Term of Service

No. of Days No. of Days

FROM

THROUGH

Scheduled in Served in

Mo Day Year Mo Day Year School Year School Year

PART-TIME TEACHER (ONLY COLLEGES/UNIVERSITIES)

Term of Service

Hours Worked in

FROM

THROUGH

School year

Mo

Day Year

Mo Day Year

ALL SCHOOLS: Is your school a public school?

Yes No

ONLY FLORIDA PUBLIC SCHOOLS: Did employee have a Continuing or Professional Service Contract? Yes No

Grade(s) or subject(s) taught/comments:

Did this teacher hold a valid teaching certificate during his/her tenure? (Applies only to private Pre-K through 12) Yes No

Please provide your Telephone No.:

E-mail Address:

Please print your name:

AUTHORIZED SIGNATURE

TITLE

DATE

STATE

COUNTRY FM-1958E Rev. (04-13)

ESCUELAS P?BLICAS DEL CONDADO MIAMI-DADE VERIFICACI?N DE EXPERIENCIA PEDAG?GICA

N?mero de empleado/a de M-DCPS (si lo conoce) CANDIDATO: LLENE ESTA SECCI?N Y ENV?ELA A CADA UNO DE LOS EMPLEADORES DE LOS CUALES EST? SOLICITANDO VERIFICACI?N DE EXPERIENCIA.

(Nombre de la escuela/instituci?n anterior) (Direcci?n)

(Ciudad)

(Estado/Pa?s)

(C?digo postal)

DEVUELVA LOS ORIGINALES (NO COPIAS O FACS?MILES)

A : MIAMI-DADE COUNTY PUBLIC SCHOOLS Compensation Administration 1450 NE 2nd Ave., Suite 621 Miami, FL 33132

NOMBRE DEL/DE LA EMPLEADO/A: _____________________________________________, No. de Seguro Social _______________________, ha sido empleado por las Escuelas P?blicas del Condado Miami-Dade, Miami, Florida.

Cargo que se anticipa ocupar? en las Escuelas P?blicas del Condado Miami-Dade (Por ejemplo: maestro/a de quinto grado, maestro/a de artes del lenguaje, maestro/a de ciencias, etc.):

PARA SER LLENADO SOLAMENTE POR EL EMPLEADOR ANTERIOR: La verificaci?n de la experiencia pedag?gica se requiere por motivos salariales del estado y el condado.

Por favor marcar si empleado(a) se a jubilado de su distrito escolar o instituci?n:

Si

No A?o de Jubilaci?n:

INSTRUCCIONES: Por favor, llene este formulario con la mayor exactitud posible, seg?n sus archivos personales o de n?mina, use una l?nea para cada a?o laborado. (Si tuviese preguntas, por favor, env?enos un correo electr?nico a compensation@ o llame al tel?fono 305-995-7040.)

Nombre y direcci?n del distrito escolar o instituci?n de ense?anza superior:

(Si fuese diferente a la anterior)

MAESTRO/A A TIEMPO COMPLETO (DE PREKINDERGARTEN A DUOD?CIMO GRADO,

"COLLEGES", UNIVERSIDADES)

Periodo de Empleo

DESDE Dia Mes A?o

HASTA Dia Mes A?o

N?mero de d?as

programados en el a?o escolar

N?mero de d?as que prest?

servicios en el a?o escolar

MAESTRO/A A TIEMPO PARCIAL (SOLAMENTE PARA "COLLEGES"/UNIVERSIDADES)

Periodo de Empleo

DESDE Dia Mes A?o

HASTA Dia Mes A?o

Horas trabajadas en el

a?o escolar

TODAS LAS ESCUELAS:

?Es su escuela una escuela p?blica?

S?

No

Grado(s) o asignatura(s) que ense??/comentarios:

?Pose?a el/la maestro/a un certificado v?lido para ense?ar durante su permanencia en el cargo? (Aplica solamente a las escuelas privadas de

prekindergarten a duod?cimo grado?

S?

No

Por favor, proporcione su n?mero de tel?fono:

Direcci?n de correo electr?nico:

Por favor, escriba su nombre en letra de molde

FIRMA AUTORIZADA

T?TULO

FECHA

ESTADO

PA?S FM-1958S Rev. (04-13)

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