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The CCIS Employment Verification Form plays a crucial role in determining an employee's eligibility for subsidized child care assistance. This form requires employers to provide essential information about their employees, including the employee's job title, employment start date, and income details such as hourly rate and gross pay. Employers must also indicate whether the employee is newly hired and provide a comprehensive work schedule that outlines the days and hours worked. If the employee is on extended leave or considered a temporary hire, this information must be noted as well. The form emphasizes the importance of accuracy, as it directly impacts the employee's ability to receive financial support for child care. An authorized company representative, rather than the employee, must complete and sign the form, ensuring that the data provided is reliable. This verification process not only helps employees access necessary resources but also aids the Early Learning Resource Center in managing its programs effectively.

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Employment Verification Form

 

 

 

EMPLOYER NAME/PLACE OF EMPLOYMENT:

IMMEDIATE SUPERVISOR’S NAME:

IMMEDIATE SUPERVISOR’S TITLE:

 

 

 

 

 

 

 

 

 

I authorize the release of this information and give permission to the Early Learning Resource Center (ELRC) to verify all information contained in this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYEE’S PRINTED NAME

 

 

EMPLOYEE’S SIGNATURE

 

 

DATE

 

THE FOLLOWING SECTIONS MUST BE COMPLETED BY THEIR EMPLOYER

EMPLOYER IDENTIFICATION NUMBER (EIN):

ADDRESS OF EMPLOYMENT:

EMPLOYER’S TELEPHONE NUMBER:

(______) ______ - ____________

EMPLOYEE INFORMATION

EMPLOYEE’S JOB TITLE:

Is the above-mentioned employee newly hired?

Yes

No

EMPLOYMENT START DATE:

______ / ______ / ____________

EMPLOYMENT INCOME

HOURLY RATE:

GROSS PAY:

AVERAGE DAILY TIPS:

NEXT PAY DATE:

PAY FREQUENCY:

 

 

 

$

$

$

___ / ___ / ______

Weekly

Bi-Weekly (26 pays/year)

Twice a Month (24 pays/year)

Monthly

The employee: receives paystubs does NOT receive paystubs receives pay in CASH has access to pay online via the following website:

EMPLOYMENT SCHEDULE (Please indicate the days and hours the employee works and indicate whether the hours occur during A.M. or P.M.)

NOTE: If the schedule varies, please give a 4-week sample schedule.

WEEK ONE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK TWO

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK THREE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK FOUR

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

Effective begin date of schedule change:

EXTENDED LEAVE

Is the employee on extended leave (maternity, disability, etc.)?

Yes

No

Effective begin date of extended leave: ___ / ___ / ______

Date returned from extended leave: ___ / ___ / ______

TEMPORARY/SEASONAL EMPLOYMENT

Is the employee considered to be a temporary hire?

Yes

No

If the employee is considered a temporary hire, what is the last date of guaranteed employment? ___ / ___ / ______

If the employee is seasonal, please give: Last day of work before break: ___ / ___ / ______

 

Expected date of return following break: ___ / ___ / ______

 

 

 

 

 

 

I understand that the information I am providing will be used to determine the above-named employee’s eligibility for

subsidized child care.

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S PRINTED NAME & JOB TITLE

 

 

EMPLOYER’S SIGNATURE

 

 

DATE

 

CY 925 6/19

Employment Verification Form

Dear Employer:

One of your employees has requested assistance paying his/her child care costs. We must verify his/her employment with you. This information will help us determine if this employee is eligible for the subsidized child care program. The form must be mailed directly to the Early Learning Resource Center (ELRC).

An authorized COMPANY REPRESENTATIVE (not the employee) must complete this form.

We must have an accurate record of your employee’s work schedule and employment income. Please complete the information on the back of this page. It is very important that the hours shown are specific and defined as either A.M. or P.M. (For example, 7:30 a.m. - 3:30 p.m.). If the employee’s schedule varies, please give a 4-week sample schedule. You do not need to give a 4-week sample schedule unless the employee’s schedule varies from week to week.

Thank you for your time and assistance. If you have any questions about how to complete this form, please contact the ELRC listed below.

ELRC:

Early Learning Resource Center Region 17

PO Box 311

1430 DeKalb Street

Norristown, PA 19404-0311

(610)278-3707 or (800) 281-1116 Fax (610) 278-5161

CY 925 6/19

Form Specifications

Fact Name Description
Purpose The Ccis Employment Verification form is used to verify an employee's employment status for subsidized child care assistance.
Completion Requirement Only an authorized company representative, not the employee, can complete and sign the form.
Information Required The form requires details such as employer identification number, employee job title, income, and work schedule.
Governing Law This form is governed by state-specific laws regarding child care assistance programs, which may vary by state.

Ccis Employment Verification: Usage Guidelines

Filling out the CCIS Employment Verification form is a straightforward process, but it requires careful attention to detail. This form is essential for confirming an employee's job status and income, which will help determine eligibility for subsidized child care assistance. Follow the steps below to complete the form accurately.

  1. Employer Information: Start by entering the employer name and the place of employment.
  2. Immediate Supervisor: Provide the name and title of the immediate supervisor.
  3. Authorization: The employee must print their name, sign the form, and date it to authorize the release of information.
  4. Employer Identification Number: Fill in the Employer Identification Number (EIN).
  5. Address: Enter the address of employment.
  6. Employer’s Telephone Number: Provide the telephone number of the employer.
  7. Employee Information: Enter the employee’s job title and indicate if the employee is newly hired by selecting "Yes" or "No."
  8. Employment Start Date: Fill in the employment start date in the specified format.
  9. Employment Income: Enter the hourly rate, gross pay, average daily tips, and the next pay date. Select the appropriate pay frequency.
  10. Pay Information: Indicate whether the employee receives paystubs, pay in cash, or has access to pay online.
  11. Employment Schedule: Provide a detailed schedule for four weeks, including the days and hours worked, specifying A.M. or P.M.
  12. Extended Leave: If applicable, indicate whether the employee is on extended leave, and provide the relevant dates.
  13. Temporary/Seasonal Employment: Specify if the employee is temporary or seasonal, and provide any necessary dates.
  14. Employer Signature: Finally, the employer must print their name and job title, sign the form, and date it.

Once you have completed the form, ensure that all sections are filled out accurately. The form must be sent directly to the Early Learning Resource Center (ELRC) by the employer. Make sure to keep a copy for your records. If you have any questions during the process, don’t hesitate to reach out to the ELRC for assistance.

Your Questions, Answered

What is the purpose of the CCIS Employment Verification Form?

The CCIS Employment Verification Form is designed to verify an employee's work status and income. This information is crucial for determining eligibility for subsidized child care assistance. By completing this form, employers help ensure that their employees can access financial support for child care, which can significantly ease the burden of child-rearing expenses.

Who is responsible for filling out the form?

An authorized company representative, not the employee, must complete the CCIS Employment Verification Form. This ensures that the information provided is accurate and reliable. The representative should be someone familiar with the employee's job status, such as a supervisor or HR personnel, to provide the necessary details regarding employment and income.

What information is required from the employer?

The employer needs to provide several key details, including the employer identification number (EIN), address of employment, and the employee's job title. Additionally, the employer must specify the employee's work schedule, income details, and whether the employee is on extended leave or is considered a temporary hire. This comprehensive information is essential for evaluating the employee's eligibility for child care assistance.

How should the completed form be submitted?

The completed CCIS Employment Verification Form must be mailed directly to the Early Learning Resource Center (ELRC). It is important that the form is sent promptly to avoid delays in the employee's application for subsidized child care. Employers should ensure that all sections are filled out accurately before submission to facilitate a smooth verification process.

What should an employer do if they have questions about the form?

If an employer has questions regarding how to complete the CCIS Employment Verification Form, they should reach out to the ELRC for assistance. Contact information is provided on the form, including phone numbers and a fax number. The ELRC staff can offer guidance and clarify any uncertainties to ensure the form is filled out correctly.

Common mistakes

  1. Failing to provide the employer identification number (EIN). This number is essential for proper identification.

  2. Omitting the immediate supervisor’s name. This information is crucial for verification purposes.

  3. Not indicating whether the employee is newly hired. This detail helps assess the employee's status.

  4. Incorrectly filling out the employment income section. Ensure that gross pay, hourly rate, and average daily tips are accurate.

  5. Providing an incomplete employment schedule. All days and hours worked must be specified clearly.

  6. Neglecting to indicate if the employee is on extended leave. This affects their eligibility for benefits.

  7. Forgetting to sign the form. An authorized company representative must provide their signature.

  8. Using ambiguous time formats for the work schedule. Clearly specify A.M. or P.M. for each entry.

  9. Not providing a 4-week sample schedule when the employee's hours vary. This is necessary for accurate assessment.

  10. Failing to submit the form directly to the Early Learning Resource Center (ELRC). Ensure it reaches the correct destination.

Documents used along the form

The CCIS Employment Verification form plays a crucial role in verifying an employee's work details for subsidized child care assistance. However, it is often accompanied by other documents that provide additional information or context. Below is a list of commonly used forms and documents that may be required alongside the CCIS Employment Verification form.

  • Pay Stubs: These documents provide a detailed account of an employee's earnings over a specific period, including gross pay, deductions, and net pay. They serve as proof of income and can help verify the information provided in the employment verification form.
  • W-2 Forms: Issued by employers at the end of each tax year, W-2 forms summarize an employee's total earnings and taxes withheld. They are useful for verifying annual income and tax contributions.
  • Employment Contract: This document outlines the terms of employment, including job responsibilities, salary, and duration of employment. It can help clarify the employee's role and compensation structure.
  • Job Offer Letter: A job offer letter serves as official documentation of the employment agreement between the employer and the employee. It typically includes the job title, start date, and salary information.
  • Tax Returns: Personal tax returns can provide a comprehensive view of an individual's income over a year. They may be requested to validate income reported on the employment verification form.
  • Bank Statements: These statements can demonstrate regular income deposits, providing additional proof of financial stability. They may be reviewed to confirm the consistency of income reported.
  • Social Security Card: This document verifies the employee's identity and eligibility to work in the United States. It is often required for tax and employment verification purposes.
  • Driver's License or State ID: A government-issued ID can confirm the employee's identity and residency. It is often used in conjunction with other documents to validate personal information.
  • Letter from Employer: A formal letter from the employer can provide additional context regarding the employee's job status, work schedule, and any other relevant details that may assist in the verification process.

Gathering these documents can help ensure a smooth verification process. Each document serves a specific purpose and collectively provides a clearer picture of the employee's work situation and financial standing. If you have questions about any of these documents or how they relate to the CCIS Employment Verification form, it is advisable to consult with the Early Learning Resource Center or a qualified professional for guidance.

Similar forms

  • W-2 Form: This document provides a summary of an employee's annual wages and the taxes withheld. Like the Employment Verification Form, it confirms employment and income details necessary for financial assistance programs.
  • Pay Stub: A pay stub details an employee's earnings and deductions for a specific pay period. It serves a similar purpose to the Employment Verification Form by showing income and employment status.
  • IRS Form 1099: Used for independent contractors, this form reports income earned outside of traditional employment. It parallels the Employment Verification Form in verifying income for those not on a regular payroll.
  • Employment Contract: This document outlines the terms of employment, including job responsibilities and compensation. It is similar to the Employment Verification Form in that it confirms the employment relationship and job title.
  • Social Security Administration (SSA) Employment Verification: This request confirms employment history and earnings for SSA benefits. It aligns with the Employment Verification Form in its role of validating employment for eligibility purposes.
  • Unemployment Benefits Verification: This form is used to verify employment status for individuals applying for unemployment benefits. It shares the goal of confirming employment status and income, similar to the Employment Verification Form.
  • Background Check Authorization: This document allows employers to verify a candidate's employment history. It is akin to the Employment Verification Form, as both are used to validate employment details.
  • Child Support Verification: This form confirms an individual's employment and income for child support calculations. Like the Employment Verification Form, it is essential for determining financial obligations.

Dos and Don'ts

When filling out the CCIS Employment Verification form, it is essential to ensure accuracy and clarity. Here are some important do's and don'ts to keep in mind:

  • Do provide accurate and complete information in all sections of the form.
  • Do ensure that the employer's representative, not the employee, completes the form.
  • Don't leave any sections blank; incomplete forms may delay the verification process.
  • Don't use vague language when describing the employee's work schedule; specify the hours clearly as A.M. or P.M.

Misconceptions

Misconceptions about the CCIS Employment Verification form can lead to confusion and errors in the verification process. Below are seven common misconceptions, along with clarifications for each.

  • Only full-time employees need to complete the form. This is incorrect. The form must be completed for both full-time and part-time employees to verify their eligibility for subsidized child care.
  • Employers can submit the form without the employee's authorization. This is a misconception. The employee must authorize the release of their information by signing the form, ensuring compliance with privacy regulations.
  • The form can be completed by anyone in the company. Not true. An authorized company representative, not the employee, must complete the form to ensure accuracy and legitimacy.
  • Providing an average of hours worked is sufficient. This is misleading. Employers must provide specific hours worked, indicating whether they are A.M. or P.M., to give a clear picture of the employee's schedule.
  • Only the current employment status needs to be reported. This is incorrect. The form requires comprehensive information, including employment start dates and any extended leave the employee may be on.
  • All employees receive paystubs. This is not always the case. The form allows for different payment methods, including cash payments, which must be accurately reported by the employer.
  • The form can be submitted electronically. This is a misconception. The CCIS Employment Verification form must be mailed directly to the Early Learning Resource Center (ELRC), as specified in the instructions.

Understanding these misconceptions can help streamline the verification process and ensure that employees receive the assistance they need for their child care costs.

Key takeaways

Filling out the Ccis Employment Verification form is crucial for employees seeking assistance with child care costs. Here are key takeaways to keep in mind:

  • Employer Responsibility: An authorized company representative, not the employee, must complete the form.
  • Accurate Information: Provide precise details about the employee’s job title, income, and work schedule.
  • Employment Schedule: Clearly indicate the days and hours the employee works, specifying A.M. or P.M.
  • Sample Schedule: If the employee's schedule varies, include a 4-week sample schedule.
  • Income Details: Report the employee’s hourly rate, gross pay, and any average daily tips.
  • Pay Frequency: Indicate how often the employee is paid: weekly, bi-weekly, twice a month, or monthly.
  • Extended Leave: Note if the employee is on extended leave and provide relevant dates.
  • Temporary or Seasonal Employment: Clarify if the employee is temporary or seasonal and provide last dates of work if applicable.
  • Submission: The completed form must be mailed directly to the Early Learning Resource Center (ELRC).
  • Contact Information: If there are questions about the form, contact the ELRC for assistance.

Following these guidelines ensures a smooth verification process and helps the employee access the support they need.