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.
| Question | Answer |
|---|---|
| Form Name | Work Verification Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | employee verification form, work verification form, payroll verification, FormsPal blank texas drivers license |
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State of New Hampshire |
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756 |
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Department of Health and Human Services |
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07/07 |
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Division of Family Assistance |
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Employment Verification (Completed by Employer Only) |
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FROM: |
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Case Worker Name: |
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Telephone No: |
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Today’s Date: |
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Please complete and return by: |
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Name of Employee: |
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SSN: |
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FOR CURRENT EMPLOYMENT |
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Date of Hire: |
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Job Title: |
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Av. Hrs per Week: |
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Current Rate of Pay: $ |
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per |
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Frequency of pay: (circle one) Weekly |
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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
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FOR TERMINATED EMPLOYMENT |
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Date of Termination or Leave of Absence: |
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CIRCLE ONE: Permanent |
Temporary |
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Reason for Termination: |
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Actual Date Final Paycheck Received: |
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Gross Amount of Final Paycheck: |
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Did the employee receive money from any other sources? |
Y |
N If yes, please indicate source, |
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type, & amount (i.e., severance pay, worker’s comp, etc.): |
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Did the employee have medical insurance?
Y
N End Date? |
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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 |
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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