Employment Verification

EMPLOYMENT VERIFICATION
THIS REQUESTED INFORMATION IS REQUIRED AS VERIFICATION BY ACCSC (OUR ACCREDITING BODY) AND THE PA DEPT OF EDUCATION. YOUR COOPERATION IN COMPLETING THIS INFORMATION IS APPRECIATED.
Employee/Graduate Name*
Company Name*
Company’s Address*
Company’s Phone Number*
Format: (000) 000-0000.
YESNO
Supervisor Name*
Supervisor Email*
Date of Hire*

MonthDayYear
YesNo
Date employment ended

MonthDayYear
JOB TITLE AND PRIMARY DUTIES
Job Title*
Please list primary duties performed with this position:*
YesNo
Original Hire Date

MonthDayYear
Original Title
YesNo
As expectedLess than expectedMore than expected
YesNo
AttendanceAttitudeCooperationQuality of WorkProfessional Appearance
YesNo
Please explain why you would not consider hiring a Laurel graduate in the future
We welcome any additional comments you may have.
Signature*
Date*

MonthDayYear
Date
Should be Empty: