Louisiana Pathways Employment Verification Form

Enter the hire date at this facility for the employee named above, in the appropriate column below:*

	Administrative	Classroom	Other
Hire Date
Termination Date (if any)

Enter the number of current hours per week spent in each job area(s) (not to exceed 40 hours):*

Director Phone Number*
Please enter a valid phone number.
Director Email address*
example@example.com
Name of person verifying employment

First NameLast Name
To meet state requirements an employment verification must be signed/ verified by someone other than the employee. A director's employment verification can be signed by the owner of the center, a spouse, an assistant director, a lead teacher, or other administrative personnel in the organization. I certify that the above information is true and correct for the employee listed above.*

Clear
Your private information is not shared outside the Louisiana Department of Education and its affiliates. This form is required for all LA Pathways members.

*In order for information to be processed in a timely manner for School Readiness Tax Credit eligibility, documentation should be received by December 31 of the current year.
Should be Empty: