Fillable Experience Verification Form printable pdf download

Experience Verification Form

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Construction Superintendent

Experience Verification Form

Applicant Name: _____________________________________________________________________

(Please Print)

Business where Applicant was employed: _________________________________________________

(Please Print)

Applicant Instructions

Please print your name and the name of the company for which you worked and give this form to EACH

employer that you have worked for during the timeframe you are claiming as qualifying experience.

Employer Representative Instructions

The above Applicant has applied to become a Registered Construction Superintendent with the New

York City Department of Buildings. The Applicant indicated in his/her application that he/she gained

qualifying experience while working for the above business/firm.

Please read and follow these directions before filling out the form:



All sections of this verification form must be completed by a person authorized to by the business to

verify employee titles, duties and responsibilities.



An Employer Representative and NOT THE APPLICANT must complete all portions of this

verification form. It must be signed and notarized.



Answer every question or indicate ‘N/A’ (not applicable) when the question does not apply to you.



Once completed, please give the ORIGINAL notarized verification form(s) to the Applicant.



You may include additional information in the Comment Section or you may attach additional pages if

needed.

YOUR FAILURE TO RESPOND MAY RESULT IN THE APPLICANT’S DISQUALIFICATION

FOR THIS REGISTRATION.

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Experience Verification Form

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