Employment Income Verification printable pdf download

Employment Income Verification

Community and Health Services Department

Housing and Long Term Care

EMPLOYMENT INCOME VERIFICATION (FORM 1)

Please request your employer to fill out this form and return it to York Region. If more

than one form is needed, please contact this office.

I _____________________________ living at _________________________________,

authorize that the information requested below be given to York Region as required under

the terms of my lease.

 Please note that York Region reserves the right to contact the employer noted below

to confirm the details contained this declaration.

Tenant Signature

Date

ALL INFORMATION WILL BE TREATED AS “CONFIDENTIAL”

Employer:

Address:

Phone:

Nature of Business:

Seasonal

Yes

If hourly, state average number of hours per week (average of last 8 weeks)

Date Employment Commenced

Hourly Rate of Pay $

Gross Earnings in Past

8 Weeks

2 Months

Gross Earnings in Past Year

(Please check one)

Over time & shift bonus

Commissions

Yearly bonus

Other (e.g. car allowance)

Total Gross Earnings

Employer’s Signature

Title

Date

Date Received by Housing Provider:

Checked By:

The Regional Municipality of York, Housing York Inc.

1091 Gorham Street, Unit #104, Newmarket, ON L3Y 8X7

Tel: (905) 898-1007, 1-877-GO4-YORK (1-877-464-9675) Fax: (905) 895-5724

Internet:

Employment Income Verification