Fillable Employment Verification Request Form printable pdf download

Employment Verification Request Form

Download a blank fillable Employment Verification Request Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Employment Verification Request Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

65 Court Street

MPLOYMENT

ERIFICATION

Brooklyn, NY 11201

Tel: (718) 935-4000

EQUEST

ORM

(IF COMPLETING FORM ONLINE, USE THE TAB KEY TO

NAVIGATE BETWEEN FIELDS)

Please complete the form and submit – along with any third-party forms – to the responsible party indicated on

the website (schools.nyc.gov/offices/dhr/employmentverification). HR Connect does not fill out third party forms.

Should you have questions concerning the completion or submission of the form, please call HR Connect at

(718) 935-4000. Note: Fields denoted by an asterisk (*) must be completed.

1: E

ECTION

MPLOYEE

NFORMATION

This section must be completed so that we may access the employee’s records.

* Employee’s Name (Last, First, Middle Initial):

*File#

*EmplID

* Title:

* School # / Office Location:

Daytime Phone #: Fax # (optional):

Email Address:

Home Address:

Apt #:

City:

State:

ZIP:

2: T

ECTION

HIRD

PARTY

NFORMATION

This section should be completed only if a third-party is to receive the verification.

Third-party Contact Name:

Company or Institution:

Daytime Phone #:

Fax # (optional):

Email Address:

Address:

Suite#:

City:

State:

ZIP:

3: V

ECTION

ERIFICATION

YPE

Check the box(es) to indicate what information you are requesting and how you would like it sent.

Title of Employee

Current Salary

Date of Hire

Date Tenure Receive

Date of Separation

(retirement, resignation)

How would you/the third party like to receive the requested information (please select only one)?

Mail

Other

Fax

Additional Requests:

4: E

ECTION

MPLOYEE

IGNATURE

The employee must provide his/her signature, authorizing release of his/her employment information, before this request can be fulfilled. Even if you are a

third-party placing the request, you must obtain the employee’s signature, either on this form or in the authorization section of your company’s form.I

authorize the New York City Department of Education to release my employment informationBy Signing This Form, You Grant The DOE Permission To Send

Any And All Details Related To Your Job History With The DOE.

Employee’s Signature_____________________________________________________________________________________________