Work Verification Form PDF Details

Are you looking for a way to verify the employment of potential employees? If so, a work verification form can be a useful tool. This form can help you confirm that an individual is currently employed and has been for a given period of time. In addition, the form can provide information about an employee's position and salary. By using a work verification form, you can get important details about an applicant's employment history.

This basic report will aid you to figure out the time it will take you to complete work verification form, the number of pages it's got, and a few additional unique details about the form.

QuestionAnswer
Form NameWork Verification Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesemployee verification form, work verification form, payroll verification, FormsPal blank texas drivers license

Form Preview Example

 

State of New Hampshire

 

 

 

 

 

 

 

756

 

 

Department of Health and Human Services

 

 

 

 

 

 

 

07/07

 

 

Division of Family Assistance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment Verification (Completed by Employer Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM:

 

Case Worker Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone No:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Today’s Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please complete and return by:

 

 

 

 

 

 

 

 

Name of Employee:

 

 

 

SSN:

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR CURRENT EMPLOYMENT

 

 

 

 

 

 

 

 

 

Date of Hire:

 

 

Job Title:

 

 

 

 

 

 

 

 

 

 

Av. Hrs per Week:

 

 

Current Rate of Pay: $

 

 

 

 

per

 

 

 

Frequency of pay: (circle one) Weekly

Bi-weekly Monthly

Semi-monthly

 

 

 

 

 

 

 

 

If this is new employment, the date of the 1st paycheck:

Please indicate if the employee has any of the following deductions:

Share/Profit Sharing

Retirement Fund/IRA

Medical Insurance:

Savings Bond(s)

Credit Union Account(s) Mandatory Wage Assignment

(i.e., Child Support Assignment)

Self

Family

Do you anticipate any changes in rate of pay or hours?

Yes (use back of form to explain)

No

 

FOR TERMINATED EMPLOYMENT

 

Date of Termination or Leave of Absence:

 

 

CIRCLE ONE: Permanent

Temporary

Reason for Termination:

 

 

 

 

 

Actual Date Final Paycheck Received:

 

 

Gross Amount of Final Paycheck:

 

 

Did the employee receive money from any other sources?

Y

N If yes, please indicate source,

type, & amount (i.e., severance pay, worker’s comp, etc.):

 

 

 

 

 

Did the employee have medical insurance?

Y

N End Date?

 

COBRA

Y

N

COMPLETE THIS SECTION FOR BOTH CURRENT AND TERMINATED EMPLOYMENT Please list the employee’s gross wages for the last 4 weeks, and indicate all bonuses, tips, or commissions that are not already included in the gross wages. If the employee receives an Earned Income Tax Credit (EITC), indicate the amount of the credit.

If not already included in Gross Wages…

Actual Date Paid Gross Wages

EITC

# of Hours

Tips

Bonus

Commission

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Information Requested by the Department:

Yes, see back of form for more details

No

Signature & Title of Person Completing this Form

Company

Company Address

Thank you for your cooperation.

Date

Telephone Number

Fax Number

SR 07-05 (3YC)

Watch Work Verification Form Video Instruction

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