Employment Verification Letter Template
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1Employment Verification Letter
County Name: ___________________________
Client Name: _______________________________________
Case #: __________________
Client SSN: _________________________________________
To Be Completed By Your Employer (The following information is necessary to determine eligibility for
Child Care Assistance):
Name of the business: ________________________________________________________________
Business Address: ___________________________________________________________________
First day of Employment: ________________________ First date of Check: _____________________
Expected Weekly Work Schedule:
Sun
Mon
Tue
Wed
Thur
Fri
Sat
Total Hrs per week
Please fill in above weekly schedule – If flex schedules please mark any regular days off (OFF) – Fill in
other days with the range of hours the person may work.
Rate of Pay: $_______________
Monthly Gross Wages: $_________ Taxes Withheld:
Yes
No
Additional income (overtime/commissions/bonuses/tips*)
Yes (If yes complete the following)
No
How Much: ______________________________
How Often: ____________________________
*If tips, what percentage is reported: ________________________________________________
The above person has indicated that s/he is employed with your business. Please complete the following
information.
_________________________________________
______________________________________
Printed Name
Title
_________________________________________
Phone Number
_________________________________________
______________________________________
Signature
Date
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Parent category: Letters