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This form can be used for new employment, for clarification or if you are returning from a leave of absence.
Pay stubs: the employer indicates the Gross income of last 4 pay stubs in Section B.
Employer: please complete Sections A - D so that HCJFS may determine whether this employee is eligible for child care services.
Signature: Section D requires a signature, which indicates the information is correct to the best of the signer's knowledge.
Authorization: in Section E, the employee authorizes release of the above information to HCJFS.
| Question | Answer |
|---|---|
| Form Name | HCJFS 3050 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Edition | Rev. 5-10 |
| Where to send | HCJFS Child Care Services, 222 E. Central Parkway, Cincinnati, OH 45202 |
| Other names | HCJFS 3050, Form 3050, JFS employment verification form, Child Care Services Employment Verification Form |
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