"Employment Verification" - New York

Employment Verification is a legal document that was released by the New York State Homes and Community Renewal - a government authority operating within New York.

Form Details:

  • Released on January 1, 2019;
  • The latest edition currently provided by the New York State Homes and Community Renewal;
  • 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 fillable version of the form by clicking the link below or browse more documents and templates provided by the New York State Homes and Community Renewal.

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Download "Employment Verification" - New York

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EMPLOYMENT VERIFICATION
TO:
FROM:
(Name & Address of Employer)
(Name & Address of Owner/Management Agent)
Email: _____________________________________
RE:
Applicant/Tenant Name
Contact _________________ at (
) ______________ or
by email at ________________ if you have any questions.
Thank you for your prompt response. All information is confidential.
Unit Number (Optional)
PERMISSION FOR RELEASE OF INFORMATION
Release: I hereby authorize the release of the requested information. Information obtained under this consent is limited to information that is no older than 12 months.
There are circumstances which would require the owner to verify information that is up to 5 years old, which would be authorized by me on a separate consent, attached
to a copy of this consent.
Signature of Applicant/Tenant
Date
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employer, please fill in all blanks. Enter N/A if an item is not applicable to the above employee.
Employee Name:
Job Title:
Presently Employed:
Yes
Date First Employed
No
Last Day of Employment
Current gross wages/salary: $
(circle one)
hourly
weekly
bi-weekly
semi-monthly
monthly
yearly
other
Average # of regular hours per week:
Overtime Rate: $
per hour
Average # of overtime hours per week (not included in regular hours):
Shift Differential Rate: $
per hour
Average # of shift differential hours per week (not included in regular hours):
Commissions, bonuses, tips, other: $
(circle one) hourly
weekly
bi-weekly
semi-monthly
monthly
yearly
other
Complete only if above wage data is unavailable: Year-to-date earnings: $
From
/
/
through /
/
List any anticipated change in the employee’s rate of pay within the next 12 months:
; Effective date:
Is the employee’s work seasonal or sporadic? Yes
No
If yes, indicate the average number of weeks in the layoff period(s):
Does this employee have a 401(k), 403(b), or other retirement account? Yes
No
If yes, can the employee withdraw the funds in this
account? Yes
No
What is the appropriate agency/contact information to verify retirement account information?
Additional remarks:
Signature:
Date:
Print Your Name:
Tel. #:
Title:
Email:
Company Name:
Address:
PENALTIES FOR MISUSING THIS CONTENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or
improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who
knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than
$5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act
at 208 (a) (6), (7), and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7), and (8).
EMPLOYMENT VERIFICATION 2019
EMPLOYMENT VERIFICATION
TO:
FROM:
(Name & Address of Employer)
(Name & Address of Owner/Management Agent)
Email: _____________________________________
RE:
Applicant/Tenant Name
Contact _________________ at (
) ______________ or
by email at ________________ if you have any questions.
Thank you for your prompt response. All information is confidential.
Unit Number (Optional)
PERMISSION FOR RELEASE OF INFORMATION
Release: I hereby authorize the release of the requested information. Information obtained under this consent is limited to information that is no older than 12 months.
There are circumstances which would require the owner to verify information that is up to 5 years old, which would be authorized by me on a separate consent, attached
to a copy of this consent.
Signature of Applicant/Tenant
Date
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employer, please fill in all blanks. Enter N/A if an item is not applicable to the above employee.
Employee Name:
Job Title:
Presently Employed:
Yes
Date First Employed
No
Last Day of Employment
Current gross wages/salary: $
(circle one)
hourly
weekly
bi-weekly
semi-monthly
monthly
yearly
other
Average # of regular hours per week:
Overtime Rate: $
per hour
Average # of overtime hours per week (not included in regular hours):
Shift Differential Rate: $
per hour
Average # of shift differential hours per week (not included in regular hours):
Commissions, bonuses, tips, other: $
(circle one) hourly
weekly
bi-weekly
semi-monthly
monthly
yearly
other
Complete only if above wage data is unavailable: Year-to-date earnings: $
From
/
/
through /
/
List any anticipated change in the employee’s rate of pay within the next 12 months:
; Effective date:
Is the employee’s work seasonal or sporadic? Yes
No
If yes, indicate the average number of weeks in the layoff period(s):
Does this employee have a 401(k), 403(b), or other retirement account? Yes
No
If yes, can the employee withdraw the funds in this
account? Yes
No
What is the appropriate agency/contact information to verify retirement account information?
Additional remarks:
Signature:
Date:
Print Your Name:
Tel. #:
Title:
Email:
Company Name:
Address:
PENALTIES FOR MISUSING THIS CONTENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent
statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or
improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who
knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than
$5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or
employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act
at 208 (a) (6), (7), and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7), and (8).
EMPLOYMENT VERIFICATION 2019