HTML Preview Employment Verification Form For Apartment Rental page number 1.
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 No Last Day of Employment
Current
Wages/Salary: $ (check one)
□ hourly □ weekly □ bi-weekly □ semi-monthly □ monthly □ yearly □ other
Average # of regular hours per week:
Year-to-date earnings: $______________ from: ____/____/______ through: ____/____/______
Overtime Rate: $
per hour Average # of overtime hours per week:
Shift Differential Rate: $ per hour Average # of shift differential hours per week:
Commissions, bonuses, tips, other: $ (check one)
□ hourly □ weekly □ bi-weekly □ semi-monthly □ monthly □ yearly □ other_________________________________
List any anticipated change in the employee's rate of pay within the next 12 months:
; Effective date:
If the employee's work is seasonal or sporadic, please indicate the layoff period(s):
Additional remarks:
Employer's Signature Employer's Printed Name Date
Employer [Company] Name and Address
Employment Verification (March 2009)
Phone # Fax # E-mail
NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of
the United States as to any matter within its jurisdiction.