Office of Teaching and Leading
Division of Educator Licensure
Form VE022020
VERIFICATION OF EXPERIENCE
The Mississippi Department of Education requires verification of relevant work experience for the issuance
of certain educator and/or administrator licenses. If the experience was completed under more than one
employer, a separate form must be submitted for each employer.
TO BE COMPLETED BY THE APPLICANT:
_______________________________________________ ____________________
Last Name First Name Middle/Maiden Educator ID #
TO BE COMPLETED BY CURRENT AND/OR PREVIOUS EMPLOYER:
This is to certify that __________________________________ has served satisfactorily in our
district/school/organization in the following position(s) during the dates specified:
Note: Teaching/Administrative Experience is defined as experience accrued by a properly licensed staff
member under legal contract with an accredited public or private elementary or secondary (N-12) school, or
Teaching/Administrative experience accrued at a state-approved or regionally/nationally accredited
Community/Junior College or Institution of Higher Education. Experience as an intern, graduate assistant,
student teacher, or in a position such as substitute teacher, aide, or clerical worker will not be considered.
*Select “NA” if applying for a Three-Year Alternative Administrator License for Non-
Education Prospective Superintendents.
_________________________________________ ____________________
Signature of Superintendent, Principal, or Personnel Staff Title
_________________________________________ ____________________
Typed or Printed Name Phone
_________________________________________ ____________________
Name of District/School/Organization State
_________________________________________
Date
