Employer

Employee Name:*
Is the applicant currently employed with your company?*
Is the above mentioned employee newly hired?*
Employment Start Date:*
Employment Type:*
Is the employee considered to be temporary hire?*
Employee Position:*
Earned Income
Hourly Pay Rate:*
Avg tips per day:*
Gross pay amount:*
Next Pay Date:*
I understand that the information I am providing will be used to determine the above-name employee’s determination for housing.
Employer's Signature:*
Title:*
Thank you for taking the time to complete this verification - we know how valuable your time is.
Date:*