Prime Time Employment Verification

Employment Verification

Please complete the information below in order that Prime Time may verify this practitioner’s employment at your out-of-school time program. This information will be kept confidential.

Verified employment records enable Prime Time to:

Provide current and accurate employment information on this practitioner’s Prime Time Out-of-School Time Registry Transcript
Determine if this practitioner is eligible for a Prime Time Scholarship
Determine if this practitioner is eligible for an ACHIEVE Out-of-School Time Incentive Award

These programs encourage your staff to continue with their professional development, thereby positively affecting the quality of your afterschool program, reducing staff turn-over, and retaining a well-qualified workforce. Click here to learn about Prime Time supports, offerings and incentives.

After you complete this form, please click the “Next Button” at the bottom of this page. On the next page you MUST sign at the bottom of the page and click the 'Submit Signed Response' button to complete your signed response. You will know that you have correctly submitted your response when you are re-directed to the “Thank You” page. In addition, you will receive an email requesting that you verify your signature.

Staff Member Name

Please provide the name of the staff member in the email you were sent (do not include your name).

is an employee at

out-of-school time program and has applied to receive a Prime Time Scholarship or ACHIEVE Out-of-School Time Incentive Award.

Please enter this practitioner’s job title (common titles may include, but are not limited to: Academic Advisor, Counselor in Training, Counselor, Certified Counselor, Activity Leader, Floater, Program Coordinator, Assistant Director, Director or Executive Director)

Has this afterschool practitioner worked at your out-of-school time program three or more months prior to today's date?

On average, how many hours is this staff member scheduled and paid to work with children and youth at your out-of-school time program per week?

Please select all the grade levels that this practitioner works with in afterschool (select one or more):

K-5th GradeMiddle School (6th - 8th Grade)High School (9th -12th Grade)Preschool (Birth - 4 years old)

What grade level does this practitioner work with the most in afterschool?

Employment Verification

I (name)

am the out-of-school-time program director, supervisor, principal or person authorized to provide employment and wage information. I attest that the information I have provided is true and correct.

My Job Title:

Date

MM/DD/YYYY

Prime Time Palm Beach County, Inc. receives significant funding from

the Children's Services Council of Palm Beach County.

Contact Information