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Sample Income and Employment Verification Form Letter.doc
1
Income and Employment Verification Form Letter
For use by applicant when obtaining verification of income and employment
Company or Employer Name:
Name of the employee:
Rate of pay that employee receives
(e.g., $ 8.50 per hour, $200 per week):
Number of hours worked per week:
(e.g., 30 hours):
Employee’s schedule (days worked, and hours worked per day:
(e.g., Monday through Thursday 8AM – 2 PM)
Monday Tuesday Wednesday Thursday Friday
Signature by official of the company:
Name, title, phone number of company official or employer: