Verification Of Employment Form printable pdf download

Verification Of Employment Form

MC: EL

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Bar Code Area

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FS#:

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Central File Maintenance

P.O. BOX 12048

AUSTIN, TX 78711-2048

Postmaster letter

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Date:

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Employee Name:

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Employee SSN:

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Employee DOB (MM/DD/YY):

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Member #:

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VERIFICATION OF EMPLOYMENT

Dear Employer :

The Office of the Attorney General is attempting to locate the above-named person. We have received information that this

person is currently working for you or has worked for you in the past. State law requires you to provide the information

requested below. [Texas Family Code Chapter 231.302] We will keep this information confidential and will use it only for

the purpose of collecting child support.

IF this person is NO LONGER EMPLOYED by your company,

COMPLETE ONLY THE INFORMATION IN THE BOX on the other side.

IF this person is STILL EMPLOYED by your company,

PLEASE PROVIDE THE INFORMATION IN THE BOX AND ALL APPLICABLE INFORMATION BELOW THE BOX.

Please use the enclosed postage-paid envelope to return the form to our office. If you prefer, you may complete the form

online by visiting our website at

I certify that the information requested for this individual is required for the performance of this agency’s official duties.

Thank you for your assistance.

Office of the Attorney General of Texas

Title IV-D Agency

EMPLOYER ADDRESS AND CONTACT INFORMATION

Please review your address above. Unless other information is provided by you, future correspondence from the Child

Support Division (including child support orders and writs) will be sent to this address.

❏ Yes

❏ No

Is the above address correct for future correspondence?

If no, please provide correct address:

________________________________________________

(see other side)

June 2015

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Verification Of Employment Form

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