Employment Verification Form printable pdf download

EMPLOYMENT VERIFICATION

(The use of white out, black out, or alteration of original information will void this document)

Project Name:

Unit ID:

Date:

Applicant/Tenant:

SSN:

Employer Contact:

Business Name:

Contact Person:

Address:

Phone:

Fax:

City:

State:

Zip:

Email:

My Signature Authorizes Verification of My Employment Income Information:

Applicant/Tenant Signature

Date

The individual named directly above is an applicant/tenant of the IRC § 42 Low Income Housing Tax Credit Program. The information provided will

be used to determine eligibility for the program and remains confidential to the satisfaction of that stated purpose only. Your prompt response is crucial

and would be greatly appreciated.

Sincerely,

RETURN THIS FORM TO:

Project Owner/Management Agent

THIS SECTION TO BE COMPLETED BY EMPLOYER



Please answer all questions fully leaving no blanks



Please provide an employee pay history report when returning this completed form

Employee Name:

Job Title:

Presently Employed:

Yes

Date First Employed:

____/____/______

Last Date of Employment:

____/____/______

Current Wages (check one)

Hourly

Salary

$ __________

Pay Frequency

Weekly

Bi-weekly

Monthly

Semi-monthly

Yearly

Pay Method

Cash

Check

Direct Deposit

Other ________

Number of regular hours scheduled per week:

_____________

Gross Year to Date Pay:

$___________________

(If hours vary please list average anticipated)

From ____/____/____

Through ____/____/______

Gross pay from prior year:

Number of pay periods included in the YTD earnings above:_______________

Overtime Rate: $___________ per hour

Average number of OT hours per week: ______________________________

Shift Differential Rate: $___________ per hour

Average number of shift differential hours per week: ___________________

Commissions, bonus, tips, other: $___________

Frequency

Weekly

Bi-weekly

Monthly

Semi-monthly

Yearly

Other __________

List any anticipated change in the employee’s rate of pay within the next 12 months: $_______________; Effective date: ____/____/______

If the employee’s work is seasonal or sporadic, please indicate the layoff period(s) :_______________________________________________________

Is this employee eligible for unemployment during the layoff period?

Yes

Does this employee participate in a retirement plan such as 401k?

Yes

Additional Remarks:

Employer Signature

Employer Printed Name

Date

Employer Name and Address

Phone #

Fax #

E-Mail

NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department

or Agency of the United States as to any matter within its jurisdiction

Spectrum Enterprises 2013

Employment Verification Form

Related Articles

Related forms

Related Categories