PRINTABLE EMPLOYEE VERIFICATION

EMPLOYER INFO
COMPANY NAME
ADDRESS
EMPLOYEE INFO
EMPLOYEE NAME
HIRE DATE
END DATE if applicable
RATE OF PAY
FREQUENCY OF PAY
TITLE HELD
ROLES AND RESPONSIBILITIES
ELIGIBLE FOR REHIRE?
ADDITIONAL COMMENTS
REQUESTING PARTY INFO
REQUESTOR NAME
REQUESTOR CONTACT INFO
FORM COMPLETED BY
NAME
CONTACT INFO
DATE COMPLETED
SIGNATURE

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