Submit Paychecks to Determine Insurance Eligibility

Submit Paychecks to Determine Insurance Eligibility
DHS requires your last 30 days of paychecks to establish eligibility. The pay checks must be in consecutive order. Upload the paychecks that you have. If you do not have the last 30 days worth of pay checks then you must have your employer fill out the verification of earnings form that is on our website. www.eatonagencyllc.com Click on "Forms". You can also access the form with this link

https://form.jotform.com/243604140727047

The paychecks need to show how much you were paid BEFORE TAXES. If you are paid through an app then you can take screenshots but again it has to show the gross amout of pay (before taxes) and it also has to show your pay period (the dates you worked).
Name*

First NameLast Name
Social Security Number*
Date of Birth*
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Message Number
Please enter a valid phone number.Format: (000) 000-0000.
File Upload*

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Additional Comments:
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty: