Career & Technical Education Plan 2 - Summary of Occupational Experience General InformationPlease complete this form by providing your general information, indicating the vcodes of the program for which you are applying and supplying the requested information detailing past work experience. NOTE: Business and Industry Route verify 6,000 hours of occupational experience, 2,000 of which must be paid, in each subcategory specialty CTE field. Within the past six years of when you apply for your initial certification 2,000 hours must have been completed. If all or part of the 2,000 hours is more than 6 years old, an additional 300 hours of recent occupational experience (occurring in the past 2 years) is required). Name First Last Email Enter Email Confirm Email DOB - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Student ID/NetIDVcodesPlease provide the CTE vcodes for which you intend to apply. Reference VcodesPaid Occupational ExperiencePlease list past, paid occupational experiences. Verification of paid occupational experience in the specific career and technical education certificated field is required. OSPI will verify supporting documentation. Please do not send this information to the Office of CTE at EWU. Occupation 1OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Unpaid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 2OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Unpaid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 3OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Unpaid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 4OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Unpaid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 5OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Unpaid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 6OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Paid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 7OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Paid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 8OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Paid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 9OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Paid HoursDutiesEmployerVcodeReference VcodesAdd another?YesNoOccupation 10OccupationStart Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY End Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Total Number of Paid HoursTotal Number of Paid HoursEmployerVcodeReference VcodesTotal Number of Paid HoursIncluding all listed employers. Total PaidTotal UnpaidTotal CombinedAffidavit StatementPlease note that your name will populate this text from the name field above. I, (Name), certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing and all information included in this application is true and correct. If the answers to any question on the application or the moral character and personal fitness section on the application change prior to my being granted certification, I must immediately notify Career and Technical Education Certification at OSPI. Confirmation * Required I confirm this statement to be true.