HTML Preview Printable Employment Verification Form page number 1.
EMPLOYMENT VERIFICATION FORM
Complete the top portion of this form and provide a copy to employers for whom you have worked for the past three
years. Request that they complete the form and return it to you. Keep the original in your files.
____________________________________________________________________ ______________________
Last Name, First Name, Initial AMT ID#
______________________________________________________________________________________________
Address
______________________________________________________________________________________________
City, State, Zip, Country
________________________________________ _______________________________________________
Email Daytime Phone Number
Please check certification for which this form is submitted (check only one per form):
___ MT ___MLT ___COLT ___CMLA ___RPT ___RMA ___CMAS ___RDA ___CLC ___AHI ___AML
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This section to be completed by employer:
Dear Employer: The individual above is attempting to verify satisfactory employment while he/she has been under
your supervision. This form will help the above individual meet certification continuation requirements. Please return
this form to the individual when you have completed it. Thank you.
Institution:_______________________________________________________________________________________
Address:________________________________________________________________________________________
City, State, Zip, Country:___________________________________________________________________________
Employer Phone:_________________________________ Email:__________________________________
Dates of Employment: From (start date): ____________________ Through (end date):____________________
Position, title, or job function during employment:________________________________________________________
Employment status: _________Full-time ___________Part-time
Employer’s Attestation:
Through the provision of my signature below, I hereby verify that the above-named individual was employed at this place of
employment for the time duration indicated. I further attest that during the course of employment, this individual’s performance
was satisfactory or competent, according to the work requirements and standards of this institution.
Name: _____________________________________ Signature:________________________________________
Title:_______________________________________ Date:________________________________