TARRANT COUNTY COLLEGE DISTRICT
Continuing Education/Lifestyles & Community Learning

Verification of Instructor Qualifications

Hiring supervisors are required to complete this form for all CE/LCL instructors as evidence for verification of qualifications to teach in the continuing education program area(s) for which they are being hired.*
A copy of this completed form must be submitted to HR with the instructor (FT and Adjunct) hiring packet.

Campus | District Office:*field type drop-down
CIE VP/Directorfield type drop-down
CIE VP | Director ADfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Backup Adminfield type drop-down
Backup Admin ADfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Divisional Deanfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

	Applicant Last Name:*field type single line	Applicant First Name:*field type single line
row 1	Applicant Last Name:*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Applicant First Name:*field type single line Input blocked. Maximum character limit of 4000 characters reached.

	Applicant ID:field type single line	Colleague ID:field type single line
row 1	Applicant ID:field type single line Input blocked. Maximum character limit of 4000 characters reached.	Colleague ID:field type single line Input blocked. Maximum character limit of 4000 characters reached.

What do you need to do?*field type radio button
What do you need to do?Hire (New Hire, Rehire)Add a Teaching Rubric (Current Faculty Only)Salaried Staff to Teach

Rubrics Table

	Pay Categoryfield type multi line	Course Rubricfield type multi line	TCC Rubric Descriptionfield type multi line	CIP Codesfield type multi line	CIP Titlefield type multi line	Certificate Program Areafield type multi line	Instructor Requirementsfield type multi line
Row 1×	Pay Categoryfield type multi line	Course Rubricfield type multi line	TCC Rubric Descriptionfield type multi line	CIP Codesfield type multi line	CIP Titlefield type multi line	Certificate Program Areafield type multi line	Instructor Requirementsfield type multi line	×

USE THE FOLLOWING SECTIONS BELOW TO DOCUMENT HOW THIS INDIVIDUAL MEETS THE MINIMUM QUALIFICATIONS LISTED ABOVE

Degree:*

School:

Major Degree Field:

Conferred Date:

Supporting Documentation Upload:*

Institution

Degree:*

School:

Major Degree Field:

Conferred Date:

mm/yyyy

Supporting Documentation Upload:*

Certify*field type checkbox
CertifyI Certify
“By checking, you certify that the affixed official transcript was either received in a sealed envelope and opened by a TCCD representative OR was received directly to a TCCD representative’s email from an accredited institution, OR a foreign transcript evaluation received from a TCC-approved AICE or NACES member that has a U.S. equivalency evaluation.”

Current Related Professional Certification/Licensure

	Certification \| Licensure:field type single line	Number:field type single line	Date of issue:field type date	Expiration Date:field type date	Issuing Agency:field type single line
Row 1×	Certification \| Licensure:field type single line Input blocked. Maximum character limit of 4000 characters reached.	Number:field type single line Input blocked. Maximum character limit of 4000 characters reached.	Date of issue:field type date	Expiration Date:field type date	Issuing Agency:field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Supporting Documentation Upload:field type file upload
You have reached the maximum file limit: .

	Teaching/Non- Teaching:*field type drop-down	Employer:field type single line	Job/Role/Type of Work:field type multi line	FT/PT:*field type drop-down	# Years:*field type number
Row 1×	Teaching/Non- Teaching:*field type drop-down	Employer:field type single line Input blocked. Maximum character limit of 4000 characters reached.	Job/Role/Type of Work:field type multi line	FT/PT:*field type drop-down	# Years:*field type number	×

Total number of years directly related to the subject area recommended to teachfield type single line
2 years part-time equals 1 year full-time
Input blocked. Maximum character limit of 4000 characters reached.
Resume Upload*(?)field type file upload
You have reached the maximum file limit: .
Certify*field type checkbox
CertifyI Certify
"I certify that the relevant work experience provided on the attached resume and listed in the credentialing form has been confirmed"

The following signatories verify the qualifications of this instructor and that all required verifying documentation is included with submission:

	Printed Name:*field type single line	Signature:*field type signature	Date:field type date
row 1	Printed Name:*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Signature:*field type signature	Date:field type date Date will be captured on form submission

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