July 16, 2002

First Name*

Last Name*

Title or Position*

Company or Organization*

Email Address*

Contact Number*

Employee's Full Name*

Employee Number, if known

Purpose of the verification request*

Select a purposeMortgage or loanRental or housingBackground investigationGovernment benefit or programProspective employerOther

What information are you requesting?*

Current employment statusEmployment datesPosition or job titleBase salary or hourly rateAverage hours workedAdditional compensationOther information listed in the attached request

Date Needed*

Additional Instructions

Upload the employee's signed authorization.*

Upload the Verification of Employment request document.*

I certify that I am authorized to submit this request, that the attached employee authorization is valid, and that the information requested will be used only for the stated purpose.