EMPLOYMENT VERIFICATION
TO BE COMPLETED BY EMPLOYEE:
Company Name: ______________________________ Date: _______________________________
Company Address: ____________________________ Employee Name: __________________
REQUEST FOR VERIFICATION OF EMPLOYMENT
Regulations require the Housing Authority to verify employment of household/family members for the purpose of determining the family’s eligibility for rental assistance. I hereby request that you furnish information to Metro West Housing Solutions regarding my employment. I understand that this information will be kept confidential and will be used for eligibility purposes.
Employee Signature: ________________________________ Social Security Number: _____________________________________
TO BE COMPLETED BY EMPLOYER:
Date of Hire: ___________ Hourly Wage: ___________ Hours Worked Per Week: ___________
Date Current Pay Rate Became Effective: _______________ Date of Termination: ___________
Overtime Hours Per Week (Avg): __________ Overtime Wages: __________________________
Bonus $: _________ Commission $ Per Week (Avg): ________ Tip $ Per Week (Avg): _________
☐ Weekly
☐ Bi-Weekly
☐ Monthly
☐ Bi-Monthly
Signature/Title: _________________________________________________________________ Phone: ___________________________________
Date: _______________________________
This form should be completed and signed by a bona fide representative of the employer, such
as the timekeeper, bookkeeper, or accountant. In no event should it be completed by the
employee. Federal statutes provide severe penalties for any fraud, intentional
misrepresentation, or criminal connivance or conspiracy.
ALTERNATIVE FORMATS OF THIS DOCUMENT ARE AVAILABLE UPON REQUEST.
575 Union Blvd Suite 100, Lakewood, Colorado 80228 ● Phone 303-987-7580 ● TTY 711 ● www.mwhs.org
