Fillable Maternity/Paternity Leave Verification Form Fee assistance is authorized (Child Care Aware)

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Maternity/Paternity Leave Verification Form Fee assistance is authorized (Child Care Aware)

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The Maternity/Paternity Leave Verification Form Fee assistance is authorized (Child Care Aware) form is 1 page long and contains:

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  • 12 check-boxes
  • 18 other fields

Country of origin: US
File type: PDF

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Maternity/Paternity Leave Verification Form
Fee assistance is authorized for 60 days to allow spouses to submit 1 month’s worth of
consecutive paystubs verifying employment. The Maternity/Paternity Leave
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)
and will be on paid OR unpaid maternity/paternity leave.
Start date of leave: ___/___/___ Anticipated date of return: ___/___/___
Pay rate: ________ hourly weekly bi-weekly semi-monthly monthly
Pay rate after leave $________ Number of work hours per week: ________
Pay Frequency: hourly weekly bi-weekly semi-monthly monthly
Name of the personnel officer Title
1515 N Courthouse Rd, 2
nd
Floor
Arlington, VA 22201 Fax: 703 341-4103
Email: msp@usa.childcareaware.org
Toll-free 1-800-424-2246
Signature of the personnel officer Date
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MaternityPaternity Leave Verification Form Fee assistance is authorized (Child Care Aware)

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Completed 20 January 2021

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