Employment Verification
ADVERTISEMENT
1EMPLOYMENT VERIFICATION
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/tenant 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.
______________________________________
Project Owner/Management Agent
Return Form To:
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employee Name:
Job Title:
Presently Employed:
Yes
Date First Employed
No
Last Day of Employment
Current Wages/Salary: $
(check one)
□ hourly
□ weekly
□ bi-weekly
□ semi-monthly
□ monthly
□ yearly
□ other
Average # of regular hours per week:
Year-to-date earnings: $______________ from: ____/____/______ 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: $
(check 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 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.
Employment Verification (March 2009)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal