Employment Verification Form

Employee Name*

First Name

Last Name

Job Title

Presently Employed?

Yes No

Date First Employed

Date Last Employed

Current/Pervious Wages/Salary

Hourly Weekly Bi-weekly Semi-monthly Monthly Yearly Other

Please Specify

Main Responsibilities

How would you rate this employee overall?

Is this person eligible for rehire?

Yes No

Please enter your information below.

Name

First Name

Last Name

Job Title

Email

Phone

Company Address

Address Line 1

Address Line 2

City

State

ZIP Code

The information that I have entered about is correct to the best of my knowledge.

Signature

Use your mouse or finger to draw your signature above