Fillable Form 702594 Employment Verification (Michigan)

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Form 702594 Employment Verification (Michigan)

On average this form takes 8 minutes to complete

The Form 702594 Employment Verification (Michigan) form is 1 page long and contains:

  • 0 signatures
  • 27 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

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Employment Verification Form
This form is to help us verify your employment as a frontline worker between April 1 to June 30, 2020.
Responses can be typed in or handwritten, but the form must be printed and signed by hand. You or your Authorized Person
(see Part II) can return the completed form by:
• Emailing MiStudentAid@michigan.gov. If you don't have access to a scanner, you can take a picture of the completed
form and attach the image to the email;
• Faxing MI Student Aid at (517) 241-5835; or
• Mailing Michigan Student Scholarships, Grants and Outreach, P.O. Box 30462, Lansing, MI 48909.
Have a question? We’re here to help. Please contact our Customer Care Center at (517) 636-7000
or MiStudentAid@michigan.gov.
Part I: TO BE COMPLETED BY THE APPLICANT
We need this information to link your Employment Verification Form(s) to your Futures for Frontliners’ application.
If you worked with more than one employer between April 1 to June 30, 2020, you must complete a new form for each employer.
Applicant
Information
Name
First
M.I.
Last
Email Address
Date of Birth
(MM/DD/YYYY)
Part II: TO BE COMPLETED BY AN AUTHORIZED PERSON
An Authorized Person is your supervisor or a Human Resources (HR) representative from your employer during April 1 – June 30, 2020,
should complete this section about your employment history during that time. If you were a contract or temporary worker, the
Authorized Person should be from the employer to which you were contracted. If you were self-employed, please check the self-
employed box, and complete this section yourself to the best of your ability.
Please check which applies:
HR Representative
Self-employed
Employer
Information
Company Name
Street Address
City
State
Zip Code
Email Address
Phone Number
Authorized
Person
Information
Name
First
M.I.
Last
Job Title
Email Address
Phone Number
Was your business considered an essential industry* between April 1 to June 30, 2020? Please choose one below. Please visit
our FAQ page if you’re not sure which one to choose.
Not an essential industry
Defense industrial base
Hazardous materials
Public works
Chemical supply chains
and safety
Energy
Healthcare and public health
Transportation and
logistics
Communications and
information technology
Financial services
Law enforcement, public safety, and
first responders
Water and wastewater
Critical manufacturing
Food and agriculture
Other community-based government
operations and essential functions
Additional critical
infrastructure workers
What was the Applicant’s job title during that time?
Was the Applicant a temporary or contract worker during that time?
Yes
No
Did the Applicant work an average of at least 20 hours per week during that time?
Yes
No
Did the Applicant work for you at least 11 of the 13 weeks during that time?
Yes
No
If you answered ‘No’ above, how many weeks did they work for you during that time?
Did the Applicant’s job require them to work outside of their home at least some of the time during that
time? If they were a home-based childcare provider, check “yes” for this question.
Yes
No
I certify that the information provided on this form is complete and accurate to the best of my knowledge and that I may be subject to
penalty for giving false or misleading information.
Signature of
Authorized Person
Date Signed
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Form 702594 Employment Verification (Michigan)

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Completed 29 September 2020

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