Dpi Pi 1613 Form PDF Details

A DPI Pi 1613 form is a required document for businesses and organizations who wish to operate in the state of Pennsylvania. The form is used to collect important information about the applicant, including their name and address, as well as their contact information. Additionally, the DPI Pi 1613 form collects data on the type of business activity or organization that is being operated. This information is used by the Pennsylvania Department of State to determine if the business or organization meets eligibility requirements to operate in the state. Filling out this form accurately and completely is essential for a successful application process. For more information on completing the DPI Pi 1613 form, please visit our website today. Thank you for your interest in doing business in Pennsylvania!

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

Dpi Pi 1613 Form PDF Details

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Dpi Pi 1613 Form – Fill Out and Use This PDF

Dpi Pi 1613 Form PDF Details

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