Employment Verification

Please fill out the form below that will be sent to your former employer to verify your employment.
Employment Verification
Company*
Address*
Note to Former Employer:

The individual referred to below has listed your company as a former employer. We would appreciate your verifying and completing the information below and faxing it back to us at (561) 383-1133 as soon as possible. Any information given will be held in the strictest confidence.
Your Name*
Email Address*
Social Security Number
Position
Start Date*

MonthDayYear
End Date*

MonthDayYear
Currently employed

Currently employed
Reason for Leaving
Additional comments
Candidate Achknowledgement
Agreement
I, ____________, hearby authorize the company or person to whom the letter is addressed to furnish ECM with any and all information requested on the form regarding my employment. I furthermore release said company or person from all liability for any damage whatsoever which may be incurred in furnishing such information.
Date*

MonthDayYear
Signature*

Clear
Should be Empty:

Candidate Achknowledgement