HTML Preview Employee Service Letter page number 1.
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SERVICE LETTER
The provisions of 19 Del. C. §708 require that we obtain a service letter from you as an employer
or former employer of the person named below. The provisions of 19 Del. C. §708 also require
any employer who receives a request for a service letter to provide the information on this form
within ten (10) business days from receipt of the request. This law provides for penalties of $1,000
- $5,000 for failing to disclose all applicable and available truthful information known to the
employer.
TO BE COMPLETED BY EMPLOYER REQUESTING SERVICE LETTER.
Name of Business/Employer requesting service letter: ____________________________
Address of Business/Employer:_______________________________________________
Type of Business of Employer requesting service letter (Check one):
_______________ Health Care Facility _________ Child Care Facility
Name of applicant: ________________________________
Social Security Number: ________________________________
From:____________ Dates of Employment: To: _______________
1. Complete Name of Business/Employer: _________________________________
Address of Business/Employer: _________________________________
TO BE COMPLETED BY EMPLOYER RECEIVING SERVICE LETTER REQUEST.
The above-named person has applied for employment/licensure with our organization. The
applicant indicated on his/her application that s/he was or is employed by you and has signed an
authorization and release form that permits you to truthfully answer these questions without
liability.
2. Dates of Service for employee: From: ______________To:__________________
If this information is not available, please explain: _________________________
Type of Business: _________________________________
3. Please answer the following questions:
A. Type of service performed by the person during the course of his/her employment.
(Please Check One.)
____ The employee was directly involved on a daily or frequent basis
providing services and/or care to clients/patients/residents/children.