EMPLOYMENT VERIFICATION FORM

[RECIPIENT NAME]
[RECIPIENT STREET ADDRESS]
[RECIPIENT CITY, STATE, ZIP]
[RECIPIENT PHONE]

[SENDER NAME]
[SENDER STREET ADDRESS]
[SENDER CITY, STATE, ZIP]
[SENDER PHONE]

Date: [MM/DD/YYYY]

To whom it may concern:

Please accept this letter as confirmation that [NAME] ☐ is ☐ was employed at [COMPANY NAME] starting on [MM/DD/YYYY] and ending on [MM/DD/YYYY] (if applicable).

Title: [EMPLOYEE POSITION]

Type: ☐ Full-time ☐ Part-time basis of [#] hours per week.

Income: $[AMOUNT] ☐ per hour ☐ annually.

Description of Duties: [LIST EMPLOYEE DUTIES]

Signature ________________________ 
Print Name: [NAME]
Title: [TITLE]