Employment Verification Form 1
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EMPLOYMENT VERIFICATION
THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT
TO:

(Name & address of employer)

Date:

RE:
Applicant/Tenant Name

Social Security Number

Unit # (if assigned)

I hereby authorize release of my employment information.
Signature of Applicant/Tenant

Date

The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
______________________________________
Project Owner/Management Agent

Return Form To:

THIS SECTION TO BE COMPLETED BY EMPLOYER
Employee Name:

Job Title:

Presently Employed:

Yes

Date First Employed

Current Wages/Salary: $
hourly
weekly

bi-weekly

per hour

Shift Differential Rate: $

monthly

yearly

Last Day of Employment
other

Year-to-date earnings: $______________ from: ____/____/______ through: ____/____/______

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