Verification of Employment
Fax:
Email:
To:
Re: Verification of employment information supplied by an applicant for housing.
To Whom It May Concern: We ask your cooperation in providing the following information and returning it to the property listed at the top of the page. Your prompt return of this information will help to assure timely processing of the applications. The applicant has consented to the release information as shown below.
Applicants Name:
Social Security Number:
Present Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do not sign this form if either the requesting organization or the organization supplying the information is left blank.
RELEASE: I HEREBY AUTHORIZE THE RELEASE OF THE REQUESTED INFORMATION. Information obtained under this content is limited to information that is no older than 12 months. There are circumstances which would require the owner to verify information that is up to 5 years old, which would be authorized by me on a separate content attached to a copy of this consent.
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Information Being Requested:
Base Pay Rate (per hour)
Or Per Week
Or Per Month
Overtime pay rate per hour
If paid hourly, please indicate average hours worked each week during current and past year
Overtime
Other compensation not included above (Specify for commission, bonuses, tips, etc.)
Total anticipated earnings for the next 12 calendar months (base pay)
Overtime
Has employment been terminated?
Yes
No
If yes, date of termination:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Last day worked:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signed/Title
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Continue
Continue
Should be Empty: