Employment Verification Form

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									This Employment Verification Form is a sample form drafted for use by an educational
institution’s financial aid office to record and verify a student’s employment status. This
form contains fields for both the student’s personal information as well as information to
be completed by the student’s current or past employer, including the dates of
employment and the student’s salary. This form can be modified to fit the needs of any
organization or institutions seeking to record and verify a student’s employment status.
                                                                                                                 Date Received:
                                                                                                                 Logged in by:
                                                                                                                 Evaluated by:
                                                                                                                 Evaluated on:

                                        EMPLOYMENT VERIFICATION FORM
                                                               FINANCIAL AID OFFICE

Student Information
                                                                                                 Perm Number

Last Name     (PRINT)                     First Name                        M.I.                 Social Security Number

Address (include apartment number)                                                               Date of Birth

City                           State                   ZIP Code                                  Phone Number (include area code)

To complete your Request for Review Due to Loss of Income, additional information is required to verify your loss of
earnings. Please sign below to authorize the release of information and then give this form to your present or previous
employer. When the Employment Verification Form is completed by the employer, return it with all other required forms to the
address above.

If you are not presently employed, when was your last date of employment?

Employee Name:                                                              Relationship to Student:

 I certify that the information I have provided is true and complete to the best of my knowledge. I agree to provide proof supporting the information on
 this form, if requested. I certify that any copies of tax returns that I have provided are true copies of the documents as filed with the IRS. I realize that
 giving false or misleading information may result in a $20,000 fine, a prison sentence, or both.

Student’s Signature:                                                                                        Date:

Parent’s Signature:                                                                                         Date:

Employer Section: To be completed by current or previous employer
Company Name:

Business Telephone:
Please complete all information that is applicable:

The individual named above is/was employed beginning: Month               Day        Year
Ending employment date:                                 Month             Day        Year
                                                         Currently employed by the company

Gross Salary                                     $__________________                          per week                per month              per year
Total Earned Year-to-Date                        $__________________
Estimated 2008 Earnings                          $__________________

Name of person completing this form (please print): ____________________________________

Signature:                                                                                   Date:

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