Pd 407-065 - Verification Of Unemployment Period Of Applicant For Appointment

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APD-20
VERIFICATION OF UNEMPLOYMENT
PERIOD OF APPLICANT
PD 407-065 (Rev. 10-08)
LIST NO. ___________
EXAM NO. _________
(Date)
VERIFICATION OF UNEMPLOYMENT PERIOD OF APPLICANT FOR APPOINTMENT
I, ________________________________________________________________, residing at
________________________________________________________________________________
do hereby state that I was unemployed during the following period:
From: ____________________
To: ____________________
During the above period, I resided at ______________________________________________
_________________________________________________________________________________
with ____________________________________________________________________________.
(Full name and relationship)
I was supported during this period of unemployment by ________________________________
_________________________________________________________________________________
During this period of unemployment, I spent my time __________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(Candidate’s Signature)

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