Form Inst-2 - Occupational Experience Verification Form - Colorado Division Of Private Occupational Schools Page 2

INST-2

Rev07.26.13

OCCUPATIONAL EXPERIENCE VERIFICATION

P

O

S

P

RIVATE

CCUPATIONAL

CHOOL

ERSONNEL

Important:

Before completing this form, please read Page 1 for verification guidelines and specific occupational

experience requirements. Instructors teaching General Education subjects are not required to complete this

form. Verification of occupational experience is an essential requirement for qualification to instruct an occupational

program/course at a Colorado Private Occupational School. This form PROPERLY COMPLETED, must be INCLUDED WITH

the Instructor Application for Private Occupational School Personnel, INST-1 . One form for each past employer or each

period of self-employment IS REQUIRED. Please copy and use additional forms as needed for EACH employer.

SECTION 1 -- TO BE COMPLETED BY THE APPLICANT:

__________________________________________________________________________________________________

Full Name (printed)

Phone

__________________________________________________________________________________________________

Full Address

Please sign below to authorize the employer to verify your occupational experience in the section below. (This employer is

not the Private School Owner of school for which you are applying.)

___________________________________________________

Applicant Signature

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

This form is not valid unless the following area is completed

.

SECTION 2 -- TO BE COMPLETED BY THE EMPLOYER

SELF, IF SELF-EMPLOYED:

OR

(Self-employment must be notarized)

The above-named person was employed from ___________________ to ___________________

Month / Year

Month / Year

:

This was Full-____ or Part-____ Time

Please note total hours

(1 year full-time = 2,000 hours)

He/She was employed as a

_________________________________________________________________________

Job Classification

Description of Duties: _______________________________________________________________________

_________________________________________________________________________________________

Firm______________________________________________________ Phone__________________________

Address___________________________________________________________________________________

Printed Name_______________________________________

Signature __________________________________________

(If self-employed, sign in presence of Notary)

Employer: Please return this form to the applicant!

___________________________________________________________________________________________________________________________

(Area for Notary)

- - - For Self Employment only - - -

_______________________________________

Notary Public

Colorado DHE/Division of Private Occupational Schools

Occupational Experience Verification - Page 2 of 2