Employment Verification Request Form
ADVERTISEMENT
1Shepard Hall, Room 50
th
Convent Avenue at 138
Street
New York, NY 10031
TEL: 212.650.7226
FAX: 212.650.7504
OFFICE OF HUMAN
RESOURCES
Employment Verification Request Form
Personal Information
______________________
_____________________
________
Last:
First:
M:
_____/_____/_______
__________
DOB:
Last 4 SS#: XX-XX-
Employment History
From:____________________ To: ____________________ Contract Title: ___________________________
From:____________________ To: ____________________ Contract Title: ___________________________
From:___________________ To: ____________________ Contract Title: ___________________________
Department:__________________________________
Include Salary?
YES
NO
Funds Source:
Tax-Levy
Non-Tax Levy
Research Foundation
Reason For Request
Pension purposes?
YES
NO
Other:__________________
NYCERS
NYC-TRS
NYS-TRS
If yes, which is your pension plan?
Mortgage
Loan
Employment
Other
Other:
Contact Information
____________________
_________________________
Telephone/Office Ext:
Email Address:
_____________________________________
__________________
:
Signature of Employee/Requester
Date:
By my signature, I hereby consent to the release of the information requested above.
**Third party requesters must have a release signed by former or current employee.
Please be advised that The City College of New York, Human Resources Office only verifies the position, salary and dates of employment for
current and former employees. Access to personnel files will not be permitted.
E-mail (listed above)
U.S. Mail:______________________________
Fax: ____________________
Special
___________________________________________________________________________________________
Requests:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
All verifications will be emailed directly to the Employee unless otherwise specified. Please allow up to seven (7) business days for processing.
EMPL
OFFICE USE ONLY:
N#:_____________
ID:__________
REQ DATE:__________________ DATABASES USED:
CUNY FIRST
PAY SERV
ADP
OTHER:___________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal