Texas Employment Verification Form PDF Details

Texas employers are now required to use the Texas Employment Verification Form (TEVF) for all new hires, effective September 1, 2017. The TEVF is a mandatory, online system that verifies the employment eligibility of new employees. It replaces the previous paper-based employment verification process. Employers who fail to use the TEVF may face civil and/or criminal penalties. The TEVF is an important tool for ensuring compliance with federal immigration laws. All new hires must complete the form and provide their Social Security number or Individual Taxpayer Identification Number (ITIN). The form can be completed in English or Spanish.

You can find information about the type of form you would like to submit in the table. It can tell you how long it will take to finish texas employment verification form, what parts you will have to fill in, etc.

QuestionAnswer
Form NameTexas Employment Verification Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
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Form Preview Example

EMPLOYMENT VERIFICATION

RELEASE OF INFORMATION

Client Name / Nombre del Cliente

Account Number / Número de Cuenta

Employee Name:

This individual is a member of a household applying for healthcare assistance from the Texas Department of State Health Services / Newborn Screening Benefits. To determine this household’s eligibility, it is necessary to verify all earnings. Since this individual is/was/will be your employee, your help is needed.

Please completely and accurately provide the information requested on the back of this letter. If a question does not apply, mark it N/A. After you complete this form, give it to your employee, mail it to the above address, or fax it to the number listed below.

This information is needed by this date: ______________________. If you could send it

before this date, it would be most appreciated.

Thank you for helping. If you have questions, please feel free to call.

I give my permission to release the information requested on this form.

Yo doy mi permiso para que mi empleador dé la información que se pide en esta forma.

Employee Signature / Firma

Date / Fecha

Comments:

Send completed form to NBS Benefits

FAX - 512-776-7593 OR e-mail - NBSBenefits@dshs.texas.gov

Questions? Call (512) 776-2983 or 800-252-8023 ext. 2983

Newborn Screening Benefits

Updated 03/2019

EMPLOYMENT VERIFICATION

Employee Name

(as shown on your records)

Employee Address – Street, City, State, ZIP (as shown on your records)

Is/was/will this person (be) employed by you? Yes No If yes Permanent Temporary

Is FICA or FIT withheld?

Yes

No

Date Hired

Rate

$

Average Hours

How often is

 

of Pay

 

Per Pay Period

employee paid?

Per Hour Per Day Per Week Per Month Per Job

Date First Paycheck Received:

If employee is/was on Leave Without Pay

Start Date:

 

End Date:

If this person no longer works for you:

Date Final of Paycheck:

Gross Amount of Final Paycheck: $

Is health insurance available? Yes

No

 

If Yes, employee is Not Enrolled

Enrolled for Self Only

Enrolled with Family Member

 

 

 

On the chart below, list all wages received by this employee during the months of:

Date Pay

Period Ended

Date Employee

Received Paycheck

Actual Hours

Gross Pay

Other Pay *

(Overtime, Tips, Bonuses, Commissions,

Pension Plan, Profit Sharing, Tips)

*Comments: (In the space above, please explain when and how Other Pay is received.)

____________________________________________________________________

_______________________

Signature and Title of Person Verifying This Information

Date

Company or Employer

Address (Street, City, State, ZIP)

Telephone

Send completed form to NBS Benefits

FAX - 512-776-7593 OR e-mail - NBSBenefits@dshs.texas.gov Questions? Call (512) 776-2983 or 800-252-8023 ext. 2983

Newborn Screening Benefits

Updated 03/2019

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