SAINT LUCIE PUBLIC SCHOOLS, FLORIDA
RETURN TO:
Personnel Department
St. Lucie Public Schools
4204 Okeechobee Road
Fort Pierce, FL 34947
VERIFICATION OF EXPERIENCE
PROFESSIONAL SUPPORT STAFF
Please verify the previous employment of ___________________________________, whose *Social
Security Number is _________________________________, in the space provided below.
TO ENSURE PROPER CREDIT FOR EXPERIENCE, THE REMAINDER OF THIS FORM MUST BE
COMPLETED IN FULL BY PREVIOUS EMPLOYER. Credit for a year of service is given only when the period of
service exceeds one-half of an actual annual contractual period by at least one day.
 USE A SEPARATE LINE FOR EACH YEAR OF EXPERIENCE.
 RETURN COMPLETED FORM TO THE ABOVE ADDRESS
Actual dates of employment:
from ______/_______/_____ to ______/_______/_____
Mo
Day
Yr
Date of
Employment by
Year
July 1 – June 30
Example:
Number
Days in Your
Work/School
Year
Example:
Total Number
Days Worked
Per Year
July 1 – June 30
Example:
Hours
Worked
Per Day
Full
Time
Part
Time
Example:
Ex:
Ex.
1999-2000
2000-2001
250
250
250
234
7.5
7.5
X
X
Mo
Day
Yr
Name of Business/School
Position Held
Example:
Example:
St. Lucie Public Schools
St. Lucie Public Schools
Mechanic
Mechanic
Description of duties performed: ______________________________________________________________________________
_________________________________________________________________________________________________________
_____________________________________________________
Authorized Signature
_____________________________________________________
Employer
_____________________________________________________
Affix seal from Notary if the above experience is from selfowned business.
The foregoing instrument was acknowledged before me this
_______________ by________________________________
Date
(Name of person
acknowledged)
Address
who is personally known to me or who has produced
_____________________________________________________
City
State
Zip Code
_____________________________________________________
__________________________________________________
(Type and number of identification produced)
as identification.
Telephone Number (Required for random verification)
____________________________________
Signature of Notary Public
_____________________________________________________
Notary Seal
Date
*Social security numbers are collected, and will only be used, in order to conduct background checks, and, once hired, to process payroll/personnel action,
employment benefits, and retirement benefits.
PER0006 Rev. 6/2015