Career & Technical Education
Plan 2 - Summary of Occupational Experience

General Information
Please 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/NetID
Vcodes
Please provide the CTE vcodes for which you intend to apply.

Reference Vcodes
Paid Occupational Experience
Please 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 1
Occupation
Start 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 Hours
Total Number of Unpaid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 2
Occupation
Start 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 Hours
Total Number of Unpaid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 3
Occupation
Start 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 Hours
Total Number of Unpaid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 4
Occupation
Start 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 Hours
Total Number of Unpaid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 5
Occupation
Start 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 Hours
Total Number of Unpaid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 6
Occupation
Start 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 Hours
Total Number of Paid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 7
Occupation
Start 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 Hours
Total Number of Paid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 8
Occupation
Start 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 Hours
Total Number of Paid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 9
Occupation
Start 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 Hours
Total Number of Paid Hours
Duties
Employer
Vcode
Reference Vcodes
Add another?
- Yes
- No
Occupation 10
Occupation
Start 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 Hours
Total Number of Paid Hours
Employer
Vcode
Reference Vcodes
Total Number of Paid Hours
Including all listed employers.
Total Paid
Total Unpaid
Total Combined
Affidavit Statement
Please 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.