EMPLOYEE VERIFICATION FORM

Please complete all of the sections provided on this form. If you need to omit information, leave the section blank or enter “N/A.”

COMPANY NAME	HIRE DATE
EMPLOYEE NAME	END DATE if applicable
JOB TITLE HELD
PAY RATE
ROLE AND RESPONSIBILITIES	AMOUNT
FREQUENCY
BONUS INFO
AMOUNT
FREQUENCY
ADDITIONAL COMMENTS
ELIGIBLE FOR REHIRE?
YES / NO
VERIFICATION REQUEST COMPLETED FOR	REQUESTOR PHONE
FORM COMPLETED BY	DATE COMPLETED
CONTACT EMAIL	CONTACT PHONE
SIGNATURE	DATE

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