1. Educator Licensing
1500 Highway 36 West
EMPLOYMENT VERIFICATION FOR
ED # 02415-02
Roseville, MN 55113-4266 ADMINISTRATIVE LICENSURE
Process Number
Name
Address
City
State/Province/Region
Zip/Postal Code
Country
Telephone Number
Date of Birth
School, Employment or Place Where Experience Was Earned Dates of Service
(address including city and state) From: To:
Grade Subject(s) Taught Position Title if Non-Teaching If not Full-Time,
Indicate % of Full-Time
I confirm that this information is correct
Print name of authorized official Name of school district employer
Signature of authorized official Address
Title City, State, Zip Code
Date Telephone Number
Email
For superintendent or principal licensure, the applicant must verify three years of full-time, successful teaching experience in a position
for which the applicant held a valid teaching license.
For local vocational program director licensure, the applicant must verify three years of experience in vocational/career and technical
education in Minnesota while holding the appropriate license. Two of the three years must have been spent in teaching or in work
experience coordination. One of the three years may have been earned as a licensed Local Vocational Program Supervisor or earned
while holding a variance as a Local Vocational Program Director.
For director of special education licensure, the applicant must verify two years of full-time or consecutive years of half-time or more
special education teaching or special education employment in a position for which the applicant held a valid license for the position.
For all administrative license applications, do not include student teaching/practicum experiences or experiences gained while not
properly state authorized/licensed for the position. Do not include leaves-of-absence.
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