Washington DSHS Employment Verification (DSHS 14-252)

Dshs Request Identicard Form PDF Details

DSHS 14-252 (REV. 06/2020), Employment Verification, is the Washington State Department of Social and Health Services form that collects an employee's work and income details from the employer. In Section 1 the client or employee authorizes the employer to release information to DSHS and signs; the Social Security number is optional. In Section 2 the employer gives the job title, the start date and the date of the first check, whether the job is new or has ended and why, average weekly hours, the rate of pay and pay frequency, whether the job is work study and any financial aid award, actual gross income for the last three months and expected income for the current and next two months, any tips, commissions, bonuses or overtime, the weekly work schedule, and whether health insurance is available, with the coverage start date and the employee's share of the premiums. The employer or a representative signs and gives a printed name, title and phone number.