Loan For Service Employment Verification Form Page 2
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4SECTION 2: Employment (to be completed by employer)
Name of Employee:________________________ Job Title:_________________________________
Employment Start Date:_________________ Employment End Date
):______________
(if applicable
Average Number of Hours Worked Per Week:____________________________________________
(If under 36 hours, please provide copy of work schedule)
Facility Name:_____________________________________________________________________
Facility Address:___________________________________________________________________
City:________________________ County:_____________________ State:_________ Zip:_______
Name of Person Completing Form:____________________________________________________
Title of Person Completing Form:_______________________ Phone Number:__________________
Employer Email Address:____________________________________________________________
I _________________________ hereby certify that the information on section 2 of this
application is true and complete to the best of my knowledge. If asked by the New Mexico Higher
Education Department I will provide proof of the information I have given on section 2 of this
application. I understand all information can and will be used in a legal capacity if necessary.
Signature
Date
*In addition to section 2, you MUST attach a letter on official letterhead from your employer/Human
Resources Department with verification of employment, profession, start date, and hours worked
weekly.
* The New Mexico Higher Education Department reserves the right to contact the employer to verify any information reported on this form.
2048 Galisteo Street, Santa Fe, New Mexico 87505
Toll Free Phone: 1-800-279-9777, Fax: 505-476-8454
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