Form CFS678-DC "Day Care Services Eligibility - Verification of Employment Form" - Illinois

What Is Form CFS678-DC?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS678-DC by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS678-DC "Day Care Services Eligibility - Verification of Employment Form" - Illinois

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CFS 678-DC
12/2015
State of Illinois
Department of Children and Family Services
Day Care Services Eligibility - Verification of Employment Form
I hereby authorize my employer to release the below information to the Illinois Department of Children
and Family Services (IDCFS) for the purpose of verifying my current employment.
Applicant Name
Last 4 Digits of Social Security Number
Applicant Signature
Date
Number of hours per day of day care needed in a scheduled work week:
CURRENT EMPLOYER
Please complete section below
Name of Employee:
Hours employed each day:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Employer:
Address:
Phone:
Completed by (please print name)
Signature of person completing form
Date completed
Title/Position
Direct Phone Number
CFS 678-DC
12/2015
State of Illinois
Department of Children and Family Services
Day Care Services Eligibility - Verification of Employment Form
I hereby authorize my employer to release the below information to the Illinois Department of Children
and Family Services (IDCFS) for the purpose of verifying my current employment.
Applicant Name
Last 4 Digits of Social Security Number
Applicant Signature
Date
Number of hours per day of day care needed in a scheduled work week:
CURRENT EMPLOYER
Please complete section below
Name of Employee:
Hours employed each day:
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Employer:
Address:
Phone:
Completed by (please print name)
Signature of person completing form
Date completed
Title/Position
Direct Phone Number