Dpi Pi 1613 Form – Fill Out and Use This PDF

The Dpi Pi 1613 form is an employment verification document used by the Wisconsin Department of Public Instruction. It serves as a crucial tool for confirming the employment history of individuals seeking educator licensing in Wisconsin, detailing positions held within school districts. For those ready to confirm their teaching positions or other educational roles, clicking the button below will guide you through the process of filling out the form accurately.

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Dpi Pi 1613 Form PDF Details

Ensuring that educators meet the qualifications and standards set by the state is crucial in maintaining the quality of education. One key tool in this process is the Wisconsin Department of Public Instruction's Employment Verification PI-1613 form, a document designed to streamline the verification of an educator's employment history. This form serves as a bridge between employers and the Department, facilitating a thorough review of an educator's professional background. Applicants are required to fill out their personal and employment information before passing it onto their current or previous employer, who then details the specific roles and duties the educator held within their institution. Employers are tasked with verifying the accuracy of this information to the best of their knowledge, a process that underscores the seriousness and importance of truthfulness in these records. This form not only serves to confirm the success and legitimacy of the applicant's employment but also to fulfill legal requirements concerning the collection and release of social security numbers for official governmental purposes. With its careful design, the PI-1613 form plays a pivotal role in ensuring that the education system is staffed by qualified and verified professionals, thus protecting the integrity of educational standards in Wisconsin.

Question	Answer
Form Name	Dpi Pi 1613 Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	pi 1613 employment verification form, pi 1613, YY, III

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Wisconsin Department of Public Instruction

EMPLOYMENT VERIFICATION

PI-1613 (Rev. 01-10)

This form is available at dpi.wi.gov/tepdl/applications.html

INSTRUCTIONS TO EMPLOYER: Mail completed form to:

WI DEPARTMENT OF PUBLIC INSTRUCTION EDUCATOR LICENSING

P.O. BOX 7841 MADISON, WI 53707-7841

Phone Number: (800) 266-1027 or (608) 266-1027

Website: dpi.wi.gov/tepdl

To the Applicant: Complete Section I (print or type) and then send to your employer (District Administrator or Personnel Director) for completion of Sections II and III.

To the Employer: Please complete both Sections II and III. In Section II list each separate position/assignment held by the applicant within your

district on an individual line. Mail the completed form to: DPI–Educator Licensing, P.O. Box 7841, Madison, WI 53707-7841.

I. APPLICANT INFORMATION

Name Last, First, Middle, (Other/Previous)

Social Security Number*

Name of Employing School District / Agency

Location of Employment School(s), City, State

II. EMPLOYMENT HISTORY

Dates (MM/YY)					Position Detail
							If Teacher
From	To		Position Held			Type of Teacher	Grades Taught	Subjects Taught
		Teacher	Counselor	Principal	Aide	Regular
						Regular
		Other Position Specify				Substitute
						Substitute

		Teacher	Counselor	Principal	Aide	Regular
						Regular
		Other Position Specify				Substitute
						Substitute

		Teacher	Counselor	Principal	Aide	Regular
		Other Position Specify				Regular
		Other Position Specify				Substitute
						Substitute

		Teacher	Counselor	Principal	Aide	Regular
		Other Position Specify				Regular
		Other Position Specify				Substitute
						Substitute

		Teacher	Counselor	Principal	Aide	Regular
		Other Position Specify				Regular
		Other Position Specify				Substitute
						Substitute

				III. EMPLOYER VERIFICATION

TO THE BEST OF MY KNOWLEDGE, all information presented on this form is accurate and the education employment listed above was successful.

Exceptions, Limitations or Other Comments

Name of School District or Employer

Street

Signature of Employer



Title

City, State, Zip Code

Date Signed

Employer Telephone Area Code/No.

*Collection of social security number is a requirement of s. 118.19(1m) and (1r). The social security number may be released to the Department of Justice, Department of Revenue, and the Department of Workforce Development. Such information is made available to these governmental agencies for official purposes only.

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Dpi Pi 1613 Form – Fill Out and Use This PDF

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