"Verification of Employment" - Nevada

Verification of Employment is a legal document that was released by the Nevada Department of Employment, Training and Rehabilitation - a government authority operating within Nevada.

Form Details:

  • Released on November 1, 2018;
  • The latest edition currently provided by the Nevada Department of Employment, Training and Rehabilitation;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Employment, Training and Rehabilitation.

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Download "Verification of Employment" - Nevada

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State of Nevada Bureau of
Vocational Rehabilitation
Verification of Employment
Participant Name:
Case ID#:
Counselor:
Employer who issues the paycheck:
Employment site (name of company where work is completed if different from issuer of
paycheck):
Address:
Supervisor:
Phone:
Start Date: (date participant begins earning wages):
☐ hourly
☐ weekly
☐ monthly
☐ Full Time ☐ Part Time (# of hours per week):
Rate of Pay:
If part time:
☐ Set number of hours per week
☐ Number of hours per week varies: Min#
Max#
☐ Regular Schedule (days and times):
Work Schedule:
☐ Varies by Week
☐ Health Insurance If yes, participant eligible:
☐ First Day
☐ Three Months
☐ Six Months
☐ Other
Benefits:
☐ Annual Leave
☐ Sick Leave
☐ Retirement Plan
☐ Paid Holidays
☐ Other
Probationary Period: ☐ Three Months
☐ Six Months
☐ One Year
☐ Other
Job Duties (attach job description or describe below):
Job Title:
(Indicates participant is in agreement with job as described above)
Participant/Representative Signature
Date:
Employer Signature
Date:
Job Developer Signature
Date:
Please submit the completed form to the Business Development Team at businessdevelopment@detr.nv.gov
1
November 2018
State of Nevada Bureau of
Vocational Rehabilitation
Verification of Employment
Participant Name:
Case ID#:
Counselor:
Employer who issues the paycheck:
Employment site (name of company where work is completed if different from issuer of
paycheck):
Address:
Supervisor:
Phone:
Start Date: (date participant begins earning wages):
☐ hourly
☐ weekly
☐ monthly
☐ Full Time ☐ Part Time (# of hours per week):
Rate of Pay:
If part time:
☐ Set number of hours per week
☐ Number of hours per week varies: Min#
Max#
☐ Regular Schedule (days and times):
Work Schedule:
☐ Varies by Week
☐ Health Insurance If yes, participant eligible:
☐ First Day
☐ Three Months
☐ Six Months
☐ Other
Benefits:
☐ Annual Leave
☐ Sick Leave
☐ Retirement Plan
☐ Paid Holidays
☐ Other
Probationary Period: ☐ Three Months
☐ Six Months
☐ One Year
☐ Other
Job Duties (attach job description or describe below):
Job Title:
(Indicates participant is in agreement with job as described above)
Participant/Representative Signature
Date:
Employer Signature
Date:
Job Developer Signature
Date:
Please submit the completed form to the Business Development Team at businessdevelopment@detr.nv.gov
1
November 2018
State of Nevada Bureau of
Vocational Rehabilitation
Verification of Employment
TO BE COMPLETED BY JOB DEVELOPER AND PARTICIPANT
IPE Vocational Goal:
☐ Yes ☐ No
If no: Is placement consistent with participant’s employment factors (strengths, resources,
Placement is consistent with IPE Goal:
priorities, concerns, abilities and capabilities) as well as interests and informed choice AND
did the counselor pre-approve the alternative placement before it took place?
☐ Yes
☐ No Explain:
☐ Yes
☐ No
If no: Was it pre-approved by the counselor in writing before the placement was made?
Is placement within the referral criteria provided by BVR?
☐ Yes, Provide date of pre-approval:
☐ No, Explain:
Placement is in an integrated setting and the participant is earning pay and benefits at the
☐ Yes
☐ No If no, explain:
same rate as other employees without disabilities who do the same or a similar job and is
earning no less than the State minimum wage?
☐ Yes
☐ No
If no, Explain and include estimate of duration:
Position is Permanent:
Participant is satisfied with job offer including the rate of pay, job duties, hours, location etc.:
☐ Very Satisfied
☐ Mostly Satisfied
☐ Somewhat Satisfied
☐ Not Satisfied
☐ Would like something better but willing to start here (for example: to gain
☐ Very Unsatisfied
experience, or something better not available – such as no business is located conveniently to the
participant’s home, therefore he/she must work a distance from his/her home).
If answer is other than “very satisfied” or “mostly satisfied”, please explain:
Other Participant Comments (optional):
Other Job Developer Comments (optional):
Participant/Representative Signature
Date:
Job Developer Signature
Date:
Please submit the completed form to the Business Development Team at businessdevelopment@detr.nv.gov
2
November 2018
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