Employer to Complete: Dates of Employment. If employment has ended, also complete this section.
Payroll records: if it is more convenient or you need more space, please substitute copies of the employee's payroll records.
Time period: if indicated on the front side, complete the following information for the time period indicated on page 1 of this form.
Eligibility: this information will be used to determine eligibility for Cash Assistance; Food Assistance; Medical Assistance; Other, specify.
Authority: Ohio Revised Code 5101.37 authorizes the CDJFS to make investigations that are necessary in the performance of their duties.
| Question | Answer |
|---|---|
| Form Name | SWOJFS 2775 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 18 |
| Avg. time to fill out | 3 min |
| Edition | Rev 01/26 |
| Issuing agency | Hamilton County Job & Family Services |
| Who completes it | The employer (Employer to Complete) |
| Other names | SWOJFS 2775, SWOJFS2775, Employment Verification Request, Hamilton County employment verification form, JFS employment verification form |
| Official source | SWOJFS 2775 (Rev 01/26), Hamilton County Job & Family Services |
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