Verification-Occupational-Experience
VERIFICATION OF OCCUPATIONAL EXPERIENCE (Non-Teaching) The Wisconsin Technical College System (WTCS) requires that all educational personnel be hired on the basis of their education and occupational experience. Please verify the following individual’s employment as authorized below. AUTHORIZATION: To be completed by Applicant/Employee and forwarded to Employer. Print Name: _____________________________ Social Security Number: _________________________ Street Address: ______________________________ City/State/Zip: _________________________________ I authorize my present/former employer to furnish Western Technical College with the information requested below. Name of Present/Former Employer: _____________________________________________________________ Street Address: __________________________________ City/State/Zip: _______________________________ Signature: ____________________________________________________ Date: _____________________ EMPLOYMENT RECORD: To be completed by Employer and returned to Western Technical College. The above named individual is/was employed by our organization: From: (MM/DD/YYYY) _______________________ The employee is/was employed To: (MM/DD/YYYY) Full-Time: ______________________ The employee is/was employed Part-Time: For ________ hours per week for _________ weeks. For _______ hours per week for _________ weeks. Total number of Full-Time hours employed to date:_______ Total number of Part-Time hours employed to date:______ Job Title or Classification: List Primary Job Duties: (Attach position description if available) Percentage of Time: _____________________________________________________________ _________________ _____________________________________________________________ _________________ _____________________________________________________________ _________________ VERIFICATION: Employer verifies information and returns form to Western Technical College. Company Name: _____________________________________ Return Completed Form to: Street Address: ______________________________________ Western Technical College Attn: Human Resources th 400 7 Street North La Crosse, WI 54601 Fax: 608-789-4708 City/State/Zip: _______________________________________ Signature: __________________________________________ Title: ______________________________________________ Date: ______________________________________________ Attention: Sarah Jackson 608-789-6253 jacksons@westerntc.edu 10/15
