Participant Termination And Exit Interview Form, Verification Of Employment Form - Alaska Commission On Aging Page 2
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3Alaska Commission on Aging
Senior Community Service Employment Program
PO Box 110209
Juneau AK 99811-0209
VERIFICATION OF EMPLOYMENT
Participant Name ____________________________________________
Termination from Senior Community Service Employment Program_____________________
Date of Verification _______________ Employed for 30 days Yes ! No !
If No, please comment on employment status: ______________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I confirm that I have contacted the following person and have verified the employment status of
the above listed individual.
Person Contacted: _______________________
Telephone _________________
Company Contacted _____________________
Telephone _________________
Address ______________________ City ___________________ State ____________
________________________________
_______________
Grantee/SCSEP Representative
Date
Other comments
____________________________________________________________________________
____________________________________________________________________________
F:\Website\employ\ExitInterview.doc
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