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Employment Experience Form for Agencies

When applying for the Competency-Based Training and Longevity Add-on, employees of a provider agency must submit proof of their work experience to their employer, in a manner prescribed by the employer.

This optional form is for agency records only.

Provider agencies should verify employment based on their typical procedures and may request reference letters or other forms of verification for the employment listed on this form. The Employment Experience form does not need to be submitted to DODD.