Illinois Wage Verification Form – Fill Out and Use This PDF

The Illinois Wage Verification Form is surveyed by employers throughout our great state to ensure that wages are paid in accordance with Illinois labor laws and regulations. Working hard deserves fair payment and the state will make sure workers are protected. Those completing and signing this form can rest assured knowing it applies labor law requirements appropriately. The Illinois Department of Labor works hard to ensure that both employee and employers understand how wages must be paid legally within the state so as to protect everybody's financial wellbeing. This form is an important component of Illinois’s inclusive and progressive approach to labor standards regulation.

Illinois Wage Verification Form PDF Details

Are you an Illinois employer in need of a wage verification form? States often require employers to provide employees with certified documents verifying their wages. In Illinois, employers must be prepared to fill out and submit the appropriate paperwork when requested by employees or third parties—such as lenders, creditors, courts, and other state agencies—to validate salary information. This guide provides step-by-step instructions on how to complete an Illinois Wage Verification Form.

Question	Answer
Form Name	Illinois Wage Verification Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	illinois child care wage verification form, il444 3514 n 1 11, il 444 3514, wage verification

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State of Illinois

-~ ~,~'~Sj~='~~, Department of Human Services - Bureau of Child Care and Development ~:~~ .~ ~:_ ,~,,

`k~~~°' WAGE VERIFICATION

hereby authorize my employer to release the following information to the Illinois Department of Human Services. understand that this information may be verified by phone. Any fraudulent, false or misleading information given may result in loss of childcare payments and my child care case may be cancelled or denied.

Client Signature
Client Case Number					Date
	JOB INFORMATION: TO BE COMPLETED BY YOUR EMPLOYER ONLY.
Employee Name:					Start Date:
Rate of Hourly Pay:			Commission:		Tips:	(Monthly Average)
Rate of Hourly Pay:			Commission:		Tips:
Pay Period:	Weekly:	Bi-Weekly:			Twice Per Month:	Monthly:
Is the employee paid cash?		❑ Yes	❑ No	Employee Job Title:
				Employee Job Title:

If on leave:	Return Date:			Type of Leave:

WORK SCHEDULE: If your schedule varies, provide an example of your schedule.

MON		TOES	WED	THURS	FRI	SAT	SUN
FROM	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM
FROM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM
	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM
TO	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM	❑ AM
TO	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM	❑ PM
Do these hours vary?		If yes, please explain:
Employer/Company Name:
Employer Address:					City:
Employer Phone Number:
Employer Name Printed				Title
Employer Signature				Date
			PLEASE RETURN FORM TO:
					Illinois Action For Children
THIS FORM MUST BE COMPLETED BY YOUR					1340 South Darren Avenue, 3rd Floor
EMPLOYER AND RETURNED TO THE ADDRESS					Chicago, IL 60608
AT THE RIGHT WITHIN 10 BUSINESS DAYS.
IL444-3514(N-1-11)							Page 1 of 1

Illinois Wage Verification Form – Fill Out and Use This PDF

Illinois Wage Verification Form PDF Details

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