CHICAGO PUBLIC SCHOOLS REQUEST FOR EMPLOYMENT VERIFICATION

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					  Chicago Public Schools HR Employee Services ▪ 125 South Clark Street, Second Floor ▪ Chicago, Illinois 60603
                Telephone (773) 553-1142 ▪ Fax (773)553-5628 ▪ EmployeeServices@cps.k12.il.us

                        CHICAGO PUBLIC SCHOOLS REQUEST FOR EMPLOYMENT VERIFICATION
Purpose of Request:


Please complete the following portion of this form to expediate your request:
        Current CPS Employee                                                           Former CPS Employee

Employee ID:                                                 Social Security Number:

        Teacher                                                                        Career Service

Name

Former Name:

Former Employees please provide approximate dates of employment:

Mailing Address:

City:                           State:            Zip Code:                   Phone Number:
For office use only                                                           Employee Appeared in Person:
Form of ID Provided:                                                                                      Date:
Hire Date:                               Termination Date:                              Job Title:

Hourly Rate:                             Annual Salary:                                 Certifications:

Date Received:                           Processed by:                                  Date Processed:

All employment verification forms submitted must include a notarized signature authorizing the Department of Human
Resources to release the information requested. Individuals appearing in person to request this information must produce
valid identification before the information is released. Requests received after 4:00 p.m.will be considered received the
next business day.
To be signed by the employee:
I understand that by signing below, I authorize the Chicago Public Schools to release the information contained above for
the purpose(s) stated above. I understand that the information which will be released is for official use for the purposes
stated above, and release of any further information will require a separate, specific release and authorization.
 Employee Signature:                                                                                      Date:

Subscribed and Sworn to before me this ______________ day of ______________, 20____

                                                                                       ___________________________________
                                                                                               Notary Public
Please submit the form and documentation via fax, e-mail, or mail to:
Employee Services
125 S Clark St, Second Floor
Chicago, IL 60603
GSR # 125
EmployeeServices@cps.k12.il.us
Fax: 773.553.5628     Phone: 773.553.1142