Employment Verification Form
Fee assistance is authorized for 60 days to allow spouses to submit 1 month's worth of
consecutive paystubs verifying employment. The Employment Verification Form should be
filled out and signed by the spouse's employer.
RE: Family ID# ______________________
Name of the Employer: ______________________________________________________
Address: ______________________________________________________
______________________________________________________
Phone Number: ________________________
This is to certify that __________________________________ holds the position of
(Employee Name)
_______________________________.
Start date of position: ___/___/___
Position Type: permanent temporary position (please list end date) ___/___/___
Pay rate: ________ hourly weekly bi-weekly semi-monthly monthly
Number of work hours per week: ________
Pay Frequency: hourly weekly bi-weekly semi-monthly monthly
____________________________ ____________________________
Name of the personnel officer Title
_____________________________ ____________________________
Signature of the personnel officer Date
1515 N Courthouse Rd, 2nd Floor
Arlington, VA 22201 Fax: 703 341-4103
Email: msp@usa.childcareaware.org
Toll-free 1-800-424-2246
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