Employment Verification Form printable pdf download

Employment Verification Form

Fee assistance is authorized for 60 days to allow spouses to submit 1 month's worth of

consecutive paystubs verifying employment. The Employment Verification Form

should be filled out and signed by the spouse's employer.

RE: Family ID#

Name of the Employer:

Address:

Phone Number:

This is to certify that

holds the position of

(Employee Name)

Start date of position: ___/___/___.

Position Type:  permanent or  temporary position (please list end date) ___/___/___.

Pay rate: ________  hourly  weekly  bi-weekly  semi-monthly  monthly

Number of work hours per week: ________

Pay Frequency:  hourly  weekly  bi-weekly  semi-monthly  monthly

Name of the personnel officer

Title

Signature of the personnel officer

Date

1515 N Courthouse Rd, 11th

Arlington, VA 22201

Fax: 703 341-4103

Email:

Toll-free 1-800-424-2246

Employment Verification Form