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Content Overview

The Texas Employment Verification form serves as a crucial document in the process of confirming an individual's employment status. Designed primarily for use by employers, this form facilitates the exchange of essential information regarding an employee's work history, wages, and job classification. It includes sections for the employer to detail the employee's name, address, and Social Security number, ensuring that the verification process is both accurate and efficient. The form requires the employer to indicate whether the individual is currently employed or was previously employed, along with specifics about the nature of the job, such as full-time or part-time status. Additionally, it prompts employers to disclose the rate of pay, frequency of payment, and any benefits such as health insurance that may be available to the employee. This information is vital for state benefit applications, as it helps determine eligibility for various programs. Employers are instructed to complete the form thoroughly and return it through one of several convenient methods, ensuring that the process is accessible for both the employer and the employee. For assistance, individuals can reach out to the Texas Health and Human Services Commission through designated phone numbers, ensuring that help is readily available to those who need it.

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Name and Address
Form H1028 / 07-2022
Date
Need help? Call 2-1-1 or 877-541-7905.
Fax: 877-447-2839
Mail:
Texas Health and Human Services Commission
P O BOX 149027
Austin, Texas 78714-9027
If you are deaf, hard of hearing, or speech
impaired, call 7-1-1 or 800-735-2989. All
numbers are free to call.
Case Name Case No.
This form is for your employer. They need to fill out the form and return it by . You must agree to let them give facts about you.
Fill Out and Sign This Agreement
I,
(print your name) allow HHSC to give my Social Security number (SSN) to the employer listed on this form.
My SSN can be used to get facts about my employment. I also allow the employer listed on this form to give facts asked on this form to HHSC.
Signature Date
Employer – Your Help Is Needed
Employee or Former Employee Social Security No.
We need proof that the following person is or was your employee.
Some employers might get tax refunds or tax credits for hiring people who get certain state benefits.
To learn more, go to TexasWorkforce.org/wotc or email the Texas Workforce Commission at [email protected]
.
Employer please follow these steps.
This person lives in a home in which someone is applying for state benefits. We need to know the amount of money this person makes or
made from this job.
1. Please fill out the “Proof of Employment” form on the next page.
2. If a question doesn't apply, mark it with "N/A."
3. Return the form:
To send this back to us, you can either:
(a) give it to the employee listed above,
(b) mail it in the pre-paid envelope, or (c) fax it to 877-447-2839.
Employment Verification
Form H1028
Page 2 / 07-2022-E
Proof of employment to be filled out by the employer.
Company or Employer
Address (Street, City, State, ZIP code)
Employee Name (as shown on your records) Employee Address (Street, City, State, ZIP Code – as shown on your records)
Is (or was) this person employed by you?
Yes No
If yes, what type of job?
Full Time Part Time Permanent Temporary
If no: Stop here – sign and date the bottom of this form and return it.
If yes: Answer all the questions below. If a question doesn’t apply, write “N/A".
Rate of Pay
Per Hour Per Day Per Week Per Month Per Job
How Often Paid? Average Hours Per Pay Period
Commissions Tips Bonuses
Yes No
Overtime Pay
Frequently Rarely Never
FICA or FIT Withheld
Yes No
Profit Sharing or Pension Plan
Yes No
If yes, current value?
Health insurance available?
Yes No
If yes, employee is:
Not Enrolled Enrolled with Family Member Enrolled for Self Only
Name of Insurance Company
Date Hired Date First Check Received Average Hours Per Week If Employee is or was on Leave Without Pay:
Start Date: End Date:
Do you expect any changes to the above information within the next few months?
Yes No
If yes, explain:
On the chart below, list all wages received by this employee during the month(s) of:
Date Pay
Period Ended
Date Employee
Received Paycheck
Actual
Hours
Gross
Pay
Other Pay*
(tips, commissions, bonuses)
EITC
Advance
Total Pretax
Contributions
* Please explain (in comments section below) when and how often tips, commissions, or bonuses are received.
Comments
If this person is no longer in your employ.
Date Separated Reason for Separation Date Final Check Received Gross Amount of Final Check
Employer – Read, Sign and Date
I confirm that this information is true and correct to the best of my knowledge:
Employer Signature Date Title Area Code and Phone No.
➤ PDF File

Form Specifications

Fact Name Description
Purpose The Texas Employment Verification form is designed for employers to confirm the employment status and details of employees or former employees who are applying for state benefits.
Governing Law This form is governed by Texas state law, specifically under the Texas Health and Human Services Commission regulations.
Required Information Employers must provide specific details including the employee's job type, rate of pay, and employment duration.
Confidentiality Employees must consent to share their Social Security number with their employer, allowing the employer to disclose employment facts to the Texas Health and Human Services Commission.
Submission Methods Employers can return the completed form via mail, fax, or by giving it directly to the employee.
Contact Information If assistance is needed, individuals can call 2-1-1 or 877-541-7905 for support.
Proof of Employment Employers must fill out the “Proof of Employment” section, which includes details about the employee's pay and job status.
Health Insurance The form inquires whether health insurance is available to the employee and if they are enrolled.
Final Check Details For separated employees, the form requires information about the date of separation and the gross amount of the final paycheck.

Texas Employment Verification: Usage Guidelines

After completing the Texas Employment Verification form, the next step is to return it to the appropriate agency. Your employer will need to provide accurate information regarding your employment status. Ensure that all sections are filled out correctly to avoid any delays in processing.

  1. Begin by entering your Name and Address at the top of the form.
  2. Fill in the Date when you are completing the form.
  3. Provide the Case Name and Case No. if applicable.
  4. In the section titled Employee or Former Employee Social Security No., write your Social Security number.
  5. Read and fill out the Proof of Employment section as required by your employer.
  6. Indicate whether you are currently employed by marking Yes or No.
  7. If you answered Yes, specify the type of job you hold or held (Full Time, Part Time, Permanent, Temporary).
  8. Complete the Rate of Pay section by indicating how you are paid (Per Day, Per Week, etc.) and your Average Hours Per Pay Period.
  9. Fill out any additional compensation details like Commissions, Tips, Bonuses, and Overtime Pay.
  10. Provide information on Health Insurance availability and enrollment status.
  11. List the Date Hired and the Date First Check Received.
  12. If applicable, provide details regarding any Leave Without Pay including start and end dates.
  13. Indicate if you expect any changes to the employment information in the coming months.
  14. Complete the wage chart for the specified month(s), listing all wages received.
  15. Include any comments or explanations in the comments section if needed.
  16. If you are no longer employed, provide the Date Separated and Reason for Separation.
  17. Finally, the employer must sign and date the form, confirming the accuracy of the information provided.

Once completed, the employer can return the form by giving it to you, mailing it in the pre-paid envelope, or faxing it to the designated number. Make sure to keep a copy for your records.

Your Questions, Answered

What is the Texas Employment Verification form used for?

The Texas Employment Verification form is designed to provide necessary employment details about an individual who is applying for state benefits. Employers fill out this form to confirm the employment status and income of their current or former employees. This information is crucial for the Texas Health and Human Services Commission (HHSC) to determine eligibility for various assistance programs.

Who needs to fill out the Texas Employment Verification form?

The form must be completed by the employer of the individual seeking state benefits. It is the employer’s responsibility to provide accurate information regarding the employee's job status, income, and other relevant details. The employee must also consent to the sharing of their information for this process.

How does an employee authorize their employer to provide information?

To authorize their employer, the employee must fill out and sign the agreement section of the form. This section includes the employee's name and Social Security number, allowing the HHSC to obtain facts about their employment. The employee's signature indicates their consent for the employer to share necessary information.

What information does the employer need to provide on the form?

Employers are required to provide various details, including the employee's job title, employment status (full-time, part-time, etc.), rate of pay, average hours worked, and any additional compensation such as bonuses or tips. They must also indicate whether health insurance is available and confirm the dates of employment.

What should an employer do if a question on the form does not apply?

If a question does not apply to the employee's situation, the employer should mark it as "N/A." This helps to ensure that the form is completed accurately without leaving any questions unanswered that are not relevant.

How can the employer return the completed form?

Employers have several options for returning the completed Texas Employment Verification form. They can hand it directly to the employee, mail it using a pre-paid envelope, or fax it to the designated number, which is 877-447-2839. All these methods are free of charge, ensuring accessibility for both employers and employees.

What if the employee is no longer with the company?

If the individual is no longer employed, the employer should still complete the form, indicating the date of separation and the reason for it. This information is essential for the HHSC to understand the employee's current status and assess their eligibility for benefits accordingly.

What should an employer do if they expect changes in the employee's information?

If the employer anticipates any changes to the employee's information in the coming months, they should indicate this on the form and provide an explanation. Keeping the HHSC informed of any potential changes helps to maintain accurate records and ensures that the employee's benefits are appropriately managed.

Common mistakes

  1. Incorrect Personal Information: Failing to provide accurate names, addresses, or Social Security numbers can delay processing. Ensure all details match official records.

  2. Missing Signatures: Both the employee and employer must sign the form. A missing signature can lead to rejection.

  3. Inaccurate Employment Dates: Providing incorrect dates of employment can create confusion. Double-check these dates for accuracy.

  4. Omitting Pay Information: Not filling out the rate of pay or frequency of payment can lead to incomplete submissions. Be thorough in this section.

  5. Ignoring 'N/A' Responses: If a question does not apply, it is crucial to mark it as "N/A." Leaving it blank may result in processing delays.

  6. Failing to Provide Employment Status: Clearly indicate whether the employee is current or former. This distinction is vital for accurate processing.

  7. Not Updating Changes: If there are expected changes in employment status or pay, these should be noted on the form. Failing to do so can lead to misunderstandings.

  8. Neglecting Comments Section: Use the comments section to clarify any irregularities or additional information. This can help avoid confusion and expedite the process.

Documents used along the form

The Texas Employment Verification form is a crucial document that employers must complete to confirm the employment status of individuals applying for state benefits. Alongside this form, several other documents are often utilized to provide additional verification and support for employment claims. Below is a list of commonly used forms and documents.

  • Proof of Employment Form: This document is typically filled out by the employer to confirm the employment details of the individual. It includes information such as job title, rate of pay, and dates of employment.
  • W-2 Form: The W-2 form is issued by employers to report an employee's annual wages and the taxes withheld from their paycheck. This form serves as proof of income for the employee.
  • Pay Stubs: Pay stubs are provided to employees with each paycheck and detail the earnings for a specific pay period. They include information on gross pay, deductions, and net pay, serving as a record of employment income.
  • IRS Form 4506-T: This form allows individuals to request a transcript of their tax return from the IRS. It can be used to verify income and employment history for various purposes, including state benefit applications.

These documents collectively support the verification process and ensure that accurate information is provided to state agencies. Maintaining proper documentation is essential for both employees and employers in navigating employment verification requirements.

Similar forms

The Texas Employment Verification form shares similarities with several other documents used for employment verification and benefits processing. Here’s a list of nine documents that are comparable:

  • IRS Form W-2: This form reports an employee's annual wages and the taxes withheld. Like the Texas Employment Verification form, it confirms employment status and income details.
  • IRS Form 1099: Used for independent contractors, this form provides information on income earned. It serves a similar purpose in verifying earnings as the Texas form does for employees.
  • Employment Verification Letter: Often requested by employees, this letter from an employer confirms employment details, such as job title and salary, similar to the information required on the Texas form.
  • Social Security Administration (SSA) Employment Verification: This document verifies employment for social security benefits, sharing the goal of confirming employment status like the Texas form.
  • State Unemployment Benefits Claim Form: This form collects information about an individual's employment history to determine eligibility for benefits, paralleling the employment verification process.
  • Form I-9: Required for verifying the identity and employment authorization of individuals hired for employment in the U.S. It also confirms employment eligibility, akin to the Texas Employment Verification form.
  • Pay Stubs: These documents provide a record of earnings and deductions for each pay period. They help verify employment and income, similar to the information requested in the Texas form.
  • State Tax Withholding Forms: These forms indicate how much tax is withheld from an employee's paycheck. They provide financial details relevant to employment, similar to the Texas Employment Verification form.
  • Job Offer Letter: This document outlines the terms of employment, including salary and job responsibilities. It serves as a record of employment details, much like the Texas form does for verification purposes.

Dos and Don'ts

When filling out the Texas Employment Verification form, there are important dos and don'ts to keep in mind. This ensures the process runs smoothly and accurately.

  • Do provide accurate and complete information about the employee.
  • Do fill out the "Proof of Employment" form on the next page.
  • Do mark any questions that do not apply with "N/A."
  • Do return the form using the provided methods: hand it to the employee, mail it, or fax it.
  • Do confirm that the information you provide is true and correct.
  • Don't leave any required fields blank; this may delay processing.
  • Don't forget to sign and date the form before returning it.
  • Don't provide information about the employee that you are unsure of; it is better to leave it blank or mark it as "N/A."
  • Don't ignore any instructions given on the form; they are there for a reason.
  • Don't assume the employee knows what you filled out; communicate with them if necessary.

Misconceptions

Misconceptions about the Texas Employment Verification form can lead to confusion for both employers and employees. Here are eight common misunderstandings:

  • This form is optional for employers. Many believe that completing the form is not mandatory. However, employers are required to fill it out to verify employment for individuals applying for state benefits.
  • Only current employees need verification. Some think that only current employees require this form. In reality, it can also be used for former employees to confirm their past employment.
  • Employers can ignore questions that do not apply. There is a misconception that employers can skip questions that do not pertain to the employee. Instead, they should mark those questions as "N/A."
  • The form is only for full-time employees. Many assume that the form is only relevant for full-time positions. It applies to both full-time and part-time employees.
  • Employers must provide personal information without consent. Some employers believe they can disclose an employee's Social Security number without permission. The form explicitly requires the employee's consent for sharing this information.
  • Submission methods are limited. There is a belief that the form can only be mailed. In fact, employers can also fax the completed form or return it through the employee.
  • All employers are familiar with the form. Not all employers understand the Texas Employment Verification form. Some may need guidance on how to fill it out correctly.
  • Employers can take their time submitting the form. Some think there is no urgency in returning the form. Timely submission is crucial for the employee’s benefits application process.

Key takeaways

Filling out and using the Texas Employment Verification form is a crucial step for employers and employees alike. Here are some key takeaways to keep in mind:

  • Employer Responsibility: The employer must complete the form accurately and return it to the Texas Health and Human Services Commission. This ensures that the employee's information is verified for state benefits.
  • Employee Consent: The employee must agree to allow their Social Security number to be shared with the employer. This consent is necessary for the verification process to proceed.
  • Proof of Employment: Employers should provide detailed information about the employee's job, including their rate of pay, employment status (full-time or part-time), and any benefits offered.
  • Submission Options: Employers can return the completed form by giving it to the employee, mailing it in a pre-paid envelope, or faxing it to the designated number. Choose the method that is most convenient.