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.
| Question | Answer |
|---|---|
| Form Name | Texas Employment Verification Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | texas employment verification form printable, employment verification form texas, texas workforce innovations opportunit act employment income verification form, verification of employment form texas |
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 -
Questions? Call (512)
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 -
Newborn Screening Benefits |
Updated 03/2019 |