DEPARTMENT OF DEFENSE EDUCATION ACTIVITY (DoDEA) SCHOOLS - Verification of Professional Educator Employment for Salary Rating Purposes

Sep 21, 2026

Uploaded by Mali

Form content supports salary rating by collecting applicant identity and prior employment details for Department of Defense Education Activity (DoDEA) Schools. Section I requests applicant data, including name, SSN, former school or employment, position title, academic level, signature, and date. Section II records employment data such as pay-relevant service dates, full-time or part-time status, school-year length, employer name, and employer title, with completion described as voluntary and failure potentially delaying processing.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Verification Purpose and Reporting Burden

Privacy Act Statement

Authority and principal purposes

Routine uses and disclosure

Section I - Applicant Data

Name, SSN, former employment and position

Academic level, signature and date

Section II - Employment Data

Employment dates and employment status

Address, school-year length, employer information

CUI (When Filled In) | DEPARTMENT OF DEFENSE EDUCATION ACTIVITY (DoDEA) SCHOOLS VERIFICATION OF PROFESSIONAL EDUCATOR EMPLOYMENT FOR SALARY RATING PURPOSES | | | | | | | | | | OMB No.: 0704-0370
OMB approval expires: November 30, 2026 | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0370) . Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO REQUESTOR IN A SEALED
ENVELOPE. | | | | | | | | | | | | PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 2164; 20 U.S.C. Sections 902, 903, and 921-932; and E.O. 9397 SSN, as amended.
PRINCIPAL PURPOSE(S): Section I of this form provides applicant consent to obtain personal pay and employment information from former employers. The information applicant supplies, and that the former employer supplies in Section II will be used to verify applicant employment history to determine creditable previous experience for pay setting purposes. Information is covered by OPM/GOVT-5, "Recruiting Examining and Placement Records," [https://www.opm.gov/](https://www.opm.gov/)[ ](https://www.opm.gov/)[information-management/privacy-policy/sorn/opm-sorn-govt-5-recruiting-examining-and-placement-records.pdf. Upon entry into Federal service the form is](information-management/privacy-policy/sorn/opm-sorn-govt-5-recruiting-examining-and-placement-records.pdf. Upon entry into Federal service the form is)[ ](information-management/privacy-policy/sorn/opm-sorn-govt-5-recruiting-examining-and-placement-records.pdf. Upon entry into Federal service the form is)maintained under OPM/GOVT-1, "General Personnel Records," [https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general](https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general)personnel-records. pdf.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, the information may be disclosed outside the DoD pursuant to 5 U.S.C. 552a(b)(3) . To disclose to appropriate Federal officials pertinent workforce information for use in national or homeland security emergency/disaster response. Additional routine uses are listed in the applicable System of Records Notice: OPM/GOVT-1, General Personnel Records at: [https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general-personnel-records.pdf](https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general-personnel-records.pdf).
DISCLOSURE: Voluntary; however, failure to provide the requested information may delay or prevent the processing of an application for a teaching position. | | | | | | | | | | | | SECTION I -APPLICANT DATA | | | | | | | | | | | | 1. NAME (Last, First, Middle Initial) | | | | | | 2. SSN | | 3. FORMER SCHOOL/PLACE OF EMPLOYMENT | | | | 4. POSITION TITLE (Teacher, Counselor, Administrator, etc.) | | | | | | | | 5. FORMER SCHOOL/PLACE OF EMPLOYMENT ADDRESS
(Street, City, State, and Zip Code) | | | | 6. ACADEMIC LEVEL (X one) | | | | | c

FAQs

What is the purpose of this form for DoDEA Schools?

It verifies professional educator employment history to determine creditable previous experience for salary-setting purposes.

What information does Section I collect from the applicant?

Section I collects applicant data such as name, SSN, former school/place of employment, position title, academic level, signature, and date signed.

Is providing the requested information mandatory?

Completion is voluntary; however, failure to provide the information may delay or prevent processing of an application for a teaching position.

Sep 21, 2026

Uploaded by Mali