Yes it does. The local FSDO will want to see a completed 8710 with the appropriate areas completed.
Why you are doing this, have you considered upgrading to a Gold Seal? It's easy. You need to pass the advanced ground instructor written and have 8 out of 10 FAA pass rate.
I second the above. Moreover, many POIs for 141 schools require stage check pilots to fly with them before conferring that designation. If that happened to you, you might find your POI and ask him/her (politely) to renew you. Your ride with him/her should be enough for your POI to sign you off.
Actually, I don't work there anymore, but they wrote a letter with the dates I served as a Check Instructor.
It was a really large 141, 80+ instructors and over 900 students, all our rides were done in house, with the exception of the Chief Pilot and Asst Chief rides.
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