Fillable Printable Sample Employment Verification Form

Sample Employment Verification Form

EMPLOYMENT VERIFICATION

THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT

TO: (Name & addressof employer) Date:

RE:

Applicant/Tenant Nam eSocial Security Number Unit # (if assigned)

I hereby authorize release of my employment information.

Signature of Applicant/Tenant Date

The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will

remain confidential to satisfaction of that stated purpose only. Your prompt response is cruc ial and greatly appreciated.

______________________________________

Project Owner/Management Agent

Return Form To:

THIS SECTION TO BE COMPLETED BY EMPLOYER

Employee Name: Job Title:

Presently Employed:Yes Date First Employed No Last Day of Employment

Current

Wages/Salary: $ (check one)

□ hourly □ weekly□ bi-weekly □ semi-monthly □ monthly □ yearly□ other

Average # of regular hours pe r week:

Year-to-date earnings: $______________ from: ____/____/______ through: ____/____/______

Overtime Rate: $

per hour Average # of overtime hours per week:

Shift Differential Rate: $ per hourAverage # of shift differential hours per week:

Commissions, bonuses, tips, other: $ (check one)

□ hourly □ weekly□bi-weekly □ semi-monthly □ monthly □ yearly □ other_________________________________

List any anticipated change in the employee'srate of pay within the next 12 months:

; Effective date:

If the employee's work is seasonal or sporadic, please indicate the layoff period(s):

Additional remarks:

Employer's SignatureEmployer's Printed NameDate

Employer [Company] Nam e and Address

Employment Verification (March 2009)

Phone #Fax #E-mail

NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of

the United States as to any matter within its jurisdiction.