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.

Form NameTexas Employment Verification Form
Form Length2 pages
Fillable fields60
Avg. time to fill out12 min 34 sec
Other namestexas employment verification form, verification of employment form pdf, employment verification letter bank, employment verification form pdf

Form Preview Example



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


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


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?



Date Hired



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



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


Company or Employer

Address (Street, City, State, ZIP)


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

How to Edit Texas Employment Verification Form Online for Free

With the objective of making it as effortless to use as possible, we designed our PDF editor. The process of preparing the texas employment verification form printable is going to be very simple in the event you consider the next actions.

Step 1: Choose the orange button "Get Form Here" on the web page.

Step 2: At the moment, it is possible to change the texas employment verification form printable. Our multifunctional toolbar helps you include, remove, adjust, highlight, as well as undertake other sorts of commands to the content material and fields inside the form.

The following sections will help make up the PDF form:

example of blanks in employment verification form pdf

Jot down the data in Employee, Signature, Firma Date, Fe, cha and Comments.

part 2 to finishing employment verification form pdf

In the Send, completed, form, to, NBS, Benefits FAX, OR, email, NBS, Benefits, ds, hs, texas, gov Questions, Call, or, ext Newborn, Screening, Benefits and Updated field, emphasize the valuable particulars.

employment verification form pdf SendcompletedformtoNBSBenefits, FAXORemailNBSBenefitsdshstexasgov, QuestionsCallorext, NewbornScreeningBenefits, and Updated blanks to fill

The If, yes, Permanent, Temporary Is, FIC, A, or, FIT, withheld, Yes, No Date, Hired Rate, of, Pay Per, Hour, Per, Day, Per, Week, Per, Month, Per, Job Average, Hours, Per, Pay, Period How, often, is, employee, paid Date, First, Paycheck, Received and EndDate area is the place to indicate the rights and obligations of all sides.

Entering details in employment verification form pdf stage 4

Fill out the document by reviewing all of these fields: Gross, Amount, of, Final, Paycheck Enrolled, with, Family, Member Date, Pay Period, Ended Date, Employee Received, Paycheck Actual, Hours Gross, Pay Other, Pay Overtime, Tips, Bonuses, Commissions Pension, Plan, Profit, Sharing, Tips and Date.

GrossAmountofFinalPaycheck, EnrolledwithFamilyMember, DatePay, PeriodEnded, DateEmployee, ReceivedPaycheck, ActualHours, GrossPay, OtherPay, OvertimeTipsBonusesCommissions, PensionPlanProfitSharingTips, and Date in employment verification form pdf

Step 3: Press "Done". You can now export the PDF form.

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