EMPLOYMENT VERIFICATION
RVCDC
Low Income Housing Tax Credit Program
3233 South University Drive
North Dakota Housing Finance Agency
Fargo, ND 58104
THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT
TO: (Name & address of employer)
Date:
RE: __________________________
_________________________
________________
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my employment information.
_____________________________________________
_____________________________
Signature of Applicant/Tenant
Date
The individual named directly above is an applicant of a housing program that requires verification of income. The
information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial
and greatly appreciated.
RVCDC
Region V Community Development Corporation
___________________________________________
3233 S University Dr
Project Owner/Management Agent
Fargo, ND 58104
Return Form To:
Phone 1-800-726-7960
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employee Name:_________________________________JobTitle:_______________________________
Presently Employed: Yes
Date First Employed __________
No
Last Day of Employment_________
Current Wages/Salary: $________ (
)
hourly weekly bi-weekly semi-monthly monthly yearly other_______
circle one
Average # of regular hours per week: _____
Year –to-date earnings: $_____________ through____/____/_____
Overtime Rate: $__________ per hour
Average # of overtime hours per week: ________________
Shift Differential Rate: $________per hour
Average # of shift differential hours per week: ___________
Commissions, bonuses, tips, other: $____
(circle one) hourly weekly bi-weekly semi-monthly 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):
Additional remarks: ________________________________________________________________________
__________________________
________________________________ ______________________
Employer’s Signature
Employer’s Printed Name
Date
________________________________________________________________________________________
Employer (company) Name and Address
__________________________
_______________________________
_________________________
Phone #
Fax#
E-mail
NOTE: Section 1001 0f 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.
1
