Hcjfs 3050 Form – Fill Out and Use This PDF

The HCJFS 3050 form, also known as the Hamilton County Job and Family Services Child Care Services Employment Verification Form, serves as a crucial document for verifying employment in order to determine eligibility for child care services. It is designed for use in situations like new employment, employment clarification, or return from a leave of absence, requiring employer completion and employee verification. Individuals seeking assistance with child care services through HCJFS are prompted to ensure this form is accurately filled out and submitted by their employer within six weeks of signing.

For detailed guidance on how to correctly fill out and submit the HCJFS 3050 form, click the button below.

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Hcjfs 3050 Form PDF Details

Navigating the essentials of child care services in Hamilton County can often lead a parent or guardian down a path filled with forms and documentation, among which sits the HCJFS 3050 form—a pivotal piece of paperwork designed to confirm employment and, consequently, eligibility for child care services. Primarily aimed at consumers who have secured employment for more than a month, the form requests a month's worth of current pay stubs to verify ongoing employment. Its usage spans various scenarios, such as new employment, the need for clarification, or the return from a leave of absence, making it versatile in its application. Employers are asked to fill out comprehensive sections detailing both their and the employee's information—including the nature of the employment, pay rate, and schedule—thus ensuring a thorough evaluation of the employee's qualifications for child care support. The form serves as a bridge between employers and Hamilton County JFS Child Care Services, making the process of determining eligibility for child care assistance both streamlined and efficient. By requiring a signature from the employer, the form not only validates the information provided but also cements the employer's involvement in facilitating access to necessary child care services for their employees. This collaborative effort underscores the community's commitment to supporting working families and their children.

Question	Answer
Form Name	Hcjfs 3050 Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	hcjfs interim report, 07221 hcjfs, 2018 irs 1915 itin identification number, 3050 employment form

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Hamilton County JFS Child Care Services Employment Verification Form

Dear Consumer: If you have been employed for more than one month, please provide one month of current pay stubs as verification of your employment. This form can be used for new employment, for clarification or if you are returning from a leave of absence. Employment verification must be signed by the employer and be no more than six weeks old.

Dear Employer: Please complete Sections A – D below so that we may determine whether this employee is eligible for child care services. Return to the address checked below. We appreciate your cooperation.

HCJFS Child Care Services, 222 E. Central Parkway, Cincinnati, OH 45202

ATTN: _______________________

Fax: (513) 946 - 1830

Section A – Employer Information

Company Name:

Address:

City/State/Zip code:

Phone:

Fax Number:

Section B – Employee Information

Employee Name:					SSN:

Date of Hire:					Still Employed:		Yes	No
					If No, Last Date of Employment:
Is this person on Leave of Absence?					Scheduled return date:

Does your company issue pay stubs?					Pay frequency:		Weekly	Bi-weekly
							Monthly	Semi-monthly
Hourly Pay Rate:		Hours paid/week:		Does employee work overtime?			# of OT hours/week:		OT hourly rate:
$									$

Indicate the Gross income of last 4 pay stubs:
	Pay date_____________ $ ____________					Pay date_____________ $ ____________
	Pay date ____________ $ ____________					Pay date_____________ $ ____________

Does the employee receive tips?			If yes, what is the weekly amount?
			$

Section C – Schedule Information

	Sun	Mon	Tues	Wed	Thurs		Fri	Sat

Earliest
Start Time

Latest
End Time

Hours at
work

Does this employee work a split shift?			Number of days worked/week?			Are hours fixed or varied?

Section D – A signature is required and indicates the information is correct to the best of my knowledge.

Name and position (print)

Signature:

Date:

Section E – I authorize release of the above information to HCJFS.

Employee Signature:

Date:

HCJFS 3050 (REV. 5-10)

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Hcjfs 3050 Form – Fill Out and Use This PDF

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