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Work Verification Form

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Interior Design Examining Board
200 E. Grand, Suite 350, Des Moines, IA 50309
(515) 725-9022 | |

Interior Design Registration Work Verification Form

Section One to be completed by the Applicant

Applicant Name:                                                        First            Middle      

Firm                    Name:                                                          

Supervisor                  Name:                                                      

Description of Work:
Description of work must accurately, briefly, and concisely describe the character of the work, the 
degree of responsibility, and the location of work.

Date of Employment (mm/dd/yy)     From:   To:           

Number  of  hours  worked  per  week:         

Section Two to be Completed by the Supervisor
Please complete and e-mail the form to



Firm                    Name:                                                          

Firm                   Address:                                                         

City:                                         State:   Zip:      

Phone:     E-mail                           

Are you a registered interior designer?   Yes   No

Your evaluation of the applicant’s interior design ability is:

Do you recommend this applicant for registration?              Yes   No

Is all the information the applicant provided in Section 1 correct?     Yes   No

If         no,         please         explain:                                            

I hereby affirm/attest that all information provided above and in Section 1 is correct.

Signed:  Date:             

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