As an authorized signatory, you may only verify employment or subcontracted experience within your own district or entity.
Experience elsewhere: do not sign to verify experience obtained elsewhere.
Employment history: complete a separate line in the area provided below for each assignment and school year.
SSN: last 4 digits only.
Completed form: provide this form to the applicant for licensure upon completion.
| Question | Answer |
|---|---|
| Form Name | PI-1613 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 64 |
| Avg. time to fill out | 11 min |
| Edition | 06-25 |
| Issuing agency | Wisconsin Department of Public Instruction |
| Who signs | An authorized signatory of the educational entity |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | PI-1613, PI 1613, PI1613, DPI PI-1613, Employment Verification Form, Wisconsin Employment Verification |
| Official source | PI-1613 (Rev 06-25), Wisconsin Department of Public Instruction |
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