Employment/unemployment Verification Form printable pdf download

Employment/unemployment Verification Form

EMPLOYMENT/UNEMPLOYMENT VERIFICATION FORM

(Complete Part I or II whichever applies to your situation)

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Part I

I, _________________________ confirmed that

_________________________________

Employment HR/Personnel Representative

Client Name

( ) is currently employed with _______________________ working ________ hours per

week and has been since________________.

Date

( ) was employed with ____________________ and ended employment with company on

Company

_______________________.

Date

Signed: _____________________________________ Date: ____________________________

Title: ___________________________

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Part II

Date__________________

Name: ___________________________________________ DOB:_______________________

( ) I certify that my last date of employment was __________________ at ____________________

Date

Company

and I am unable to provide proof of unemployment either with a signed statement above or

through the Employment Security Division.

The party requesting proof of income may accept your Form 1099-G, which the state workforce agency uses to

report unemployment compensation to the Internal Revenue Service and state taxation agency. The form shows the

amount of benefits you received during the most recent tax year and the amount of taxes withheld. You may be able

to get a copy of your 1099-G by logging into your online unemployment account or calling or visiting the

unemployment agency.

( ) I certify that I have never been in the workforce.

Signature________________________________________ Date: _______________________

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Official Use Only:

I have verified the above information:

Administrative Officer: ___________________________________Date__________________________

Note:

Employment/unemployment Verification Form