Form PI-1613 at a glance
What it is: PI-1613 is the Employment Verification Form.
Who signs: This form is used by an employer to verify the employment experience of an applicant for licensure. As an authorized signatory, you may only verify employment or subcontracted experience within your own district or entity. Do not sign to verify experience obtained elsewhere.
A filled-in Form PI-1613 example: a district verifies one teacher's year
How to fill out Form PI-1613, box by box
License Applicant Legal Name and SSN
Enter the License Applicant Legal First Name, Middle Initial, Legal Last Name and SSN Last 4 Digits Only.
Employment History
Complete a separate line in the area provided for each assignment and school year.
Enter the Start Date and the End Date as MM/DD/YYYY.
Enter the FTE, for example 1.0 or .25.
Mark the Position (Teacher, Pupil Services, Administrator, Aide or Other) and the Type of Assignment (Regular, Short-term Sub. or Long-Term Sub.), then enter the Grades Served and the Subject or Position.
Employment Verification
All experience listed in Employment History was attained at my educational entity. To the best of my knowledge, the information is accurate and all education employment listed was successfully completed.
Enter the Educational Entity Name and any Exceptions, Limitations, or Other Comments.
Enter the Street Address, City, State and Zip Code.
Under Authorized Signator's Information, enter the First and Last Name (Type or print legibly), Title, Telephone Number (incl. Area Code) and Email Address.
Enter the Signature and the Date Signed.
Provide this form to the applicant for licensure upon completion.
Sources
[1] Form PI-1613 (Rev. 06-25), Employment Verification, Wisconsin Department of Public Instruction (the Official source link on this page).