What is your intention? I am VERIFYING an employee.I am REQUESTING VERIFICATION of an employee. Do you know the Employer's Name? Do you know the Employer's Name? YesNo What is the Employer's Name? Company or individual Manager / Supervisor Who is the Manager or Supervisor? Ex. Jon Smith Title (optional) Ex. Manager Employer's Contact Employer's E-Mail Employer's Phone Number Employer's Address What is the Employer's Address? Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Requestor's Name Individual or Company Requestors E-Mail Requestor's Phone Number Do you know who is REQUESTING this verification? Do you know who is REQUESTING this verification? YesNo Such as an employer, landlord, government office, etc. Requestor's Name Individual or Company Requestor's Address Your Mailing Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Name of Employee (person being verified) Title or Role Ex. Account Manager Employee's Original Start Date Employment Details Does the Employee work Full or Part Time? Does the Employee work Full or Part Time? Full-TimePart-Time How Many Hours per Week? Hours The Employee gets paid SelectHourlyDailyWeeklyBi-weekly MonthlyQuarterlyAnnually (Salary) Select the way the employee receives payment. Enter Amount $/ Hour Enter Amount $/ Daily Enter Amount $/ Weekly Enter Amount $/ Bi-weekly Enter Amount $/ Monthly Enter Amount $/ Quarterly Enter Amount $/ Annually Bonus Does the Employee earn any type of Bonus? Does the Employee earn any type of Bonus? YesNo Approximate Bonus Amount ($): (annual basis) $/ Year Give an estimate of the Employee's Annual Bonus Amount (just an estimate does not need to be exact) Signature Employer's Signature Clear Please draw your signature. Print Name Next Save Save and finish later
