Employment Verification Form printable pdf download

EMPLOYMENT VERIFICATION FORM

Complete the top portion of this form and provide a copy to employers for whom you have worked for the past three

years. Request that they complete the form and return it to you. Keep the original in your files.

____________________________________________________________________

______________________

Last Name, First Name, Initial

AMT ID#

______________________________________________________________________________________________

Address

______________________________________________________________________________________________

City, State, Zip, Country

________________________________________

_______________________________________________

Daytime Phone Number

Please check certification for which this form is submitted (check only one per form):

___ MT

___MLT

___COLT

___CMLA

___RPT

___RMA

___CMAS

___RDA

___CLC

___AHI

___AML

-----------------------------------------------------------------------------------------------------------------------------------

This section to be completed by employer:

Dear Employer: The individual above is attempting to verify satisfactory employment while he/she has been under

your supervision. This form will help the above individual meet certification continuation requirements. Please return

this form to the individual when you have completed it. Thank you.

Institution:_______________________________________________________________________________________

Address:________________________________________________________________________________________

City, State, Zip, Country:___________________________________________________________________________

Employer Phone:_________________________________

Email:__________________________________

Dates of Employment: From (start date): ____________________

Through (end date):____________________

Position, title, or job function during employment:________________________________________________________

Employment status:

_________Full-time

___________Part-time

Employer’s Attestation:

Through the provision of my signature below, I hereby verify that the above-named individual was employed at this place of

employment for the time duration indicated. I further attest that during the course of employment, this individual’s performance

was satisfactory or competent, according to the work requirements and standards of this institution.

Name: _____________________________________

Signature:________________________________________

Title:_______________________________________

Date:________________________________

Employment Verification Form

Related Articles

Related forms

Related Categories