Prior Employment Verification Form
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1PRIOR EMPLOYER VERIFICATION FORM
Shenandoah County Public Schools
600 North Main Street, Suite 200
Woodstock, VA 22664
Telephone (540) 459-6222
Fax (540) 459-6747
Please complete this section and mail form to your previous employer.
PLEASE RETURN FORM TO:
TO:
Robin M. Lamma
Shenandoah County Public Schools
600 North Main Street, Suite 200
Woodstock, VA 22664
mail or 540-459-6747 (fax)
The undersigned employee has indicated that he/she has experience in your system. Please confirm the following
information regarding experience, continuing contract status, and sick leave balance.
I hereby authorize the above school system to release information to Shenandoah County Public Schools regarding my
experience, ontinuing status, and sick leave balance.
Other name/s known by:_____________________
Employee Name (print)
Social Security #:___________________________
Date: _____________________________________
Employee Signature
THE FOLLOWING INFORMATION IS TO BE COMPLETED BY THE FORMER EMPLOYER:
This is to confirm that
was employed by our system for the following periods:
Employee Name
Resignation
Name of School
Position
Hired Date
Date
Other Remarks
Virginia School Systems Only:
A. The above named employee had an accumulated balance of _____________ sick leave days for which the employee was not
paid at the employees termination on _______________________ (Date).
B. The above named employee [
] was [
] was not under continuing contract. If under continuing contract, indicate date
granted _________________(Date).
Authorized Official _________________________________________________________ Date_____________________________
Print Name and Title
Phone:
Authorized Official________________________________________________
Signature
E-Mail Address:
Name of School System:______________________________________________________________________________________
Address:___________________________________________________________________________________________________
rm:h:personnel:prioremplverfic
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