The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Teaching Initiatives
89 Washington Avenue, Room 5N EB, Albany, New York, 12234
www.highered.nysed.gov/tcert
Verification of Occupational Work Experience Form:
Career and Technical Education (CTE) Teacher Certification
This form must be signed and sent by one of the following individuals who can verify the work experience of the certificate
applicant: supervisor or higher position title, human resources department official, or other appropriate organization official;
NYC DOE SVA Director (New York City only); or the certificate applicant (self-employed experience only).
• Instructions for the CTE certificate applicant: Please complete Sections I and II. Then, give the form to one of the
above individuals to complete Section III. The individual verifying the work experience must submit the completed
form. Separate forms must be completed for different work experiences.
o For self-employed work experience only, certificate applicants must also:
Send an IRS Schedule C for up to four years of claimed self-employment, depending on the application
pathway/option, to tcert@nysed.gov with the subject line “Attn: CTE” or to the above mailing
address, OR
Have two key associates (e.g., accountant, attorney, officer of a supply company) write letters of
recommendation and send the letters to the Office of Teaching Initiatives (OTI) at tcert@nysed.gov
with the subject line “Attn: CTE” or to the above mailing address. Letters from the certificate
applicants’ customers, employees, or family members are not acceptable. Please see the OTI
webpage to review the requirements related to the letters.
• Instructions for the individual verifying the work experience: Please complete III. The form must be submitted to
the Office of Teaching Initiatives by the employer, hiring organization, or certificate applicant (self-employed
experience only) via email to otiexpverif@nysed.gov with “Attn: CTE” in the subject line or through mail to the above
mailing address.
Please note that the end date of the work experience must be on or before today’s date and cannot be listed as “to present”.
Future dates on the form and incomplete forms will not be accepted.
Section I: Certificate applicant information
First Name: Last Name: Middle Initial:
Date of Birth: / / (mm/dd/yyyy) Last 4 Digits of Social Security Number:
Section II: Description of position
Name of previous or current employer or hiring organization: _____________________________________________________
Address of employer or hiring organization (street address, city, state, zip code):
Position title: _____________________________________________________
Full-time: Total number of full-time days worked (not days per week or hours per week):
From: / / (mm/dd/yyyy) to: / / (mm/dd/yyyy)
For volunteer occupational work experience only, certificate applicants must have held an acceptable industry related credential
or had passed an acceptable industry related exam during their volunteer experience, where applicable.
Part-time: Total number of full-time equivalent days worked (not days per week or hours per week):
From: / / (mm/dd/yyyy) to: / / (mm/dd/yyyy)
For evaluation and computational purposes, a day is considered equivalent to 7.5 hours for occupational work experience.
For volunteer occupational work experience only, certificate applicants must have held an acceptable industry-related credential or
had passed an acceptable industry related exam during their volunteer experience, where applicable.
