"Child Care Employment Verification Form" - Pennsylvania

What Is Form PA 1897?

Form PA 1897, Employment Verification Form, is a legal document completed by the employer as proof of the employee's job performance, length of employment, and character requested by a Pennsylvania child care facility. Every child care provider needs to make sure each parent has secure employment and a stable source of income and will be able to afford the monthly payments to the facility that takes care of their child. An Employment Verification Form will prove the parent's financial stability and responsibility.

This form was released by the Pennsylvania Department of Public Welfare.

The PA 1897 Form is now obsolete, and the issuing department has evolved into the Pennsylvania Department of Human Services. If you are looking for a replacement form, it is available here - you can download a fillable Form PA 1897 through the link below.

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Form PA 1897 Instructions

The PA Employment Verification Form requires the name of a child care facility who requests employment history from a parent and this parent's signature.

Then, the form must be filled out by the employer. It is necessary to state the name and social security number of the employee, and name and contact details of the employer. Indicate the dates of employment and the number of hours the employee works per week. The employer needs to specify the job title and describe the employee's duties and responsibilities. If needed, the employer may write down additional comments.

Once the form is completed, the employee will bring it to the child care provider, and the facility's representative must sign the form and enter their title, accepting the verification. The bottom part of the form allows the child care provider to calculate the number of hours, months, and years to know the extent of the employee's experience.

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Download "Child Care Employment Verification Form" - Pennsylvania

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CHILD CARE EMPLOYMENT
VERIFICATION FORM
AUTHORIZATION:
To Whom It May Concern:
I hereby authorize you to provide any information in your possession regarding my job performance, length of
employment and character to:________________________________________________________________
Employee’s Signature: ____________________________________________________________________
VERIFICATION:
Name of Employee: ________________________________________SSN_________________________
Name of Employer: ______________________________________Phone: ( __ )_____________________
Address: ________________________________________________________________________________
1. Dates of Employnent:_____________________________to_______________________________
(month/year)
(month/year)
2. Number of Hours Worked per Week:_________________________________________________
3. Position Title:___________________________________________________________________
4. Duties and Responsibilites:_________________________________________________________
________________________________________________________
5. Additional Comments (optional):____________________________________________________
Verifier’s Signature: __________________________________Title: ________________________
**************************************************************************************
FOR OFFICE USE ONLY
Total Hours per week ___________ x 4.33 weeks per month = __________________________
Total hours per month ___________ x ____________ no. of months = _____________________
Total hours ____________________ ÷ 1250 hrs/years = _______________years
CHILD CARE EMPLOYMENT
VERIFICATION FORM
AUTHORIZATION:
To Whom It May Concern:
I hereby authorize you to provide any information in your possession regarding my job performance, length of
employment and character to:________________________________________________________________
Employee’s Signature: ____________________________________________________________________
VERIFICATION:
Name of Employee: ________________________________________SSN_________________________
Name of Employer: ______________________________________Phone: ( __ )_____________________
Address: ________________________________________________________________________________
1. Dates of Employnent:_____________________________to_______________________________
(month/year)
(month/year)
2. Number of Hours Worked per Week:_________________________________________________
3. Position Title:___________________________________________________________________
4. Duties and Responsibilites:_________________________________________________________
________________________________________________________
5. Additional Comments (optional):____________________________________________________
Verifier’s Signature: __________________________________Title: ________________________
**************************************************************************************
FOR OFFICE USE ONLY
Total Hours per week ___________ x 4.33 weeks per month = __________________________
Total hours per month ___________ x ____________ no. of months = _____________________
Total hours ____________________ ÷ 1250 hrs/years = _______________years