Employment History Verification 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.Employee Name Job Title Presently Employed? Yes NoIf 'Yes' please enter first day of Employment, If 'No' please enter last day of Employment. Wage/Salary Commissions, bonusses, timps, other Hourly Weekly Bi-Weekly Semi-Monthly Monthly YearlyWage/Salary Term Hourly Weekly Bi-Weekly Semi-Monthly Monthly YearlyAverage # of regular hours per week Average # of overtime hours per week Average # of shift differential hours per week Overtime Rate Shift Differential Rate If the employee's work is seasonal or sporadic, please indicate the layoff period(s) Additional remarks Employer/Company Name Employer/Company Address Employer/Company Phone Number Employer/Company Email Completed By (Name & Title) Date / Time By checking this box I agree the content is true and accurate By checking this box I agree the content is true and accurateForm URL Submit
