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The Ccis Employment Verification Form plays a crucial role in assisting employees who seek financial support for their child care expenses. This form requires detailed information from employers to confirm the employment status of their workers. Key sections include the employer's name, contact information, and the employee's job title. Employers must indicate whether the employee is newly hired and provide essential details such as the employment start date, income, and pay frequency. Additionally, the form captures the employee's work schedule, requiring specific hours and days worked, which helps establish eligibility for subsidized child care programs. Employers also need to clarify if the employee is on extended leave or considered temporary or seasonal. By completing this form accurately, employers contribute to the well-being of their employees and facilitate access to vital child care resources.

Preview - Ccis Employment Verification Form

 

 

 

 

 

Employment Verification Form

 

 

 

EMPLOYER NAME/PLACE OF EMPLOYMENT:

IMMEDIATE SUPERVISOR’S NAME:

IMMEDIATE SUPERVISOR’S TITLE:

 

 

 

 

 

 

 

 

 

I authorize the release of this information and give permission to the Early Learning Resource Center (ELRC) to verify all information contained in this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYEE’S PRINTED NAME

 

 

EMPLOYEE’S SIGNATURE

 

 

DATE

 

THE FOLLOWING SECTIONS MUST BE COMPLETED BY THEIR EMPLOYER

EMPLOYER IDENTIFICATION NUMBER (EIN):

ADDRESS OF EMPLOYMENT:

EMPLOYER’S TELEPHONE NUMBER:

(______) ______ - ____________

EMPLOYEE INFORMATION

EMPLOYEE’S JOB TITLE:

Is the above-mentioned employee newly hired?

Yes

No

EMPLOYMENT START DATE:

______ / ______ / ____________

EMPLOYMENT INCOME

HOURLY RATE:

GROSS PAY:

AVERAGE DAILY TIPS:

NEXT PAY DATE:

PAY FREQUENCY:

 

 

 

$

$

$

___ / ___ / ______

Weekly

Bi-Weekly (26 pays/year)

Twice a Month (24 pays/year)

Monthly

The employee: receives paystubs does NOT receive paystubs receives pay in CASH has access to pay online via the following website:

EMPLOYMENT SCHEDULE (Please indicate the days and hours the employee works and indicate whether the hours occur during A.M. or P.M.)

NOTE: If the schedule varies, please give a 4-week sample schedule.

WEEK ONE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK TWO

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK THREE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK FOUR

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

Effective begin date of schedule change:

EXTENDED LEAVE

Is the employee on extended leave (maternity, disability, etc.)?

Yes

No

Effective begin date of extended leave: ___ / ___ / ______

Date returned from extended leave: ___ / ___ / ______

TEMPORARY/SEASONAL EMPLOYMENT

Is the employee considered to be a temporary hire?

Yes

No

If the employee is considered a temporary hire, what is the last date of guaranteed employment? ___ / ___ / ______

If the employee is seasonal, please give: Last day of work before break: ___ / ___ / ______

 

Expected date of return following break: ___ / ___ / ______

 

 

 

 

 

 

I understand that the information I am providing will be used to determine the above-named employee’s eligibility for

subsidized child care.

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S PRINTED NAME & JOB TITLE

 

 

EMPLOYER’S SIGNATURE

 

 

DATE

 

CY 925 6/19

Employment Verification Form

Dear Employer:

One of your employees has requested assistance paying his/her child care costs. We must verify his/her employment with you. This information will help us determine if this employee is eligible for the subsidized child care program. The form must be mailed directly to the Early Learning Resource Center (ELRC).

An authorized COMPANY REPRESENTATIVE (not the employee) must complete this form.

We must have an accurate record of your employee’s work schedule and employment income. Please complete the information on the back of this page. It is very important that the hours shown are specific and defined as either A.M. or P.M. (For example, 7:30 a.m. - 3:30 p.m.). If the employee’s schedule varies, please give a 4-week sample schedule. You do not need to give a 4-week sample schedule unless the employee’s schedule varies from week to week.

Thank you for your time and assistance. If you have any questions about how to complete this form, please contact the ELRC listed below.

ELRC:

Early Learning Resource Center Region 17

PO Box 311

1430 DeKalb Street

Norristown, PA 19404-0311

(610)278-3707 or (800) 281-1116 Fax (610) 278-5161

CY 925 6/19

Document Specifics

Fact Name Fact Description
Purpose The Ccis Employment Verification form is used to verify an employee's job status and income for subsidized child care assistance eligibility.
Employer Requirement Completion of the form must be done by an authorized representative of the employer, not the employee themselves.
Information Collected It collects various details including the employer's name, employee's job title, employment dates, income, and work schedule.
Submission Process The completed form must be mailed directly to the Early Learning Resource Center (ELRC) for processing.
State-Specific Laws The form is governed by Pennsylvania state law regarding child care assistance programs.
Extended Leave Information The form includes sections to indicate if the employee is on extended leave, such as maternity or disability leave.

Ccis Employment Verification: Usage Instruction

Completing the Ccis Employment Verification form is a straightforward process that requires careful attention to detail. Once the form is filled out accurately, it will be submitted to the Early Learning Resource Center (ELRC) to verify the employee's work status and income. This verification is crucial for assessing eligibility for subsidized child care assistance.

  1. Employer Information: Begin by entering the Employer Name/Place of Employment at the top of the form.
  2. Supervisor Details: Fill in the Immediate Supervisor’s Name and Immediate Supervisor’s Title.
  3. Authorization: The employee must print their name, sign, and date the authorization section to allow the ELRC to verify the information.
  4. Employer Identification: Provide the Employer Identification Number (EIN) and the Address of Employment.
  5. Contact Information: Enter the Employer’s Telephone Number in the specified format.
  6. Employee Details: Fill in the Employee’s Job Title and indicate whether the employee is newly hired by selecting Yes or No.
  7. Employment Dates: Record the Employment Start Date in the format provided.
  8. Income Information: Enter the Hourly Rate, Gross Pay, Average Daily Tips, Next Pay Date, and Pay Frequency.
  9. Pay Information: Indicate whether the employee receives paystubs, receives pay in cash, or has access to pay online.
  10. Work Schedule: Provide a detailed Employment Schedule for four weeks, including the days and hours worked, and specify whether the hours are A.M. or P.M. If the schedule varies, include a sample for each week.
  11. Extended Leave: Answer whether the employee is on extended leave and provide the relevant dates if applicable.
  12. Temporary/Seasonal Employment: Indicate if the employee is temporary or seasonal, and provide the last date of guaranteed employment or expected return date.
  13. Final Employer Verification: The employer must print their name and job title, sign, and date the form to complete the verification.

Learn More on Ccis Employment Verification

What is the purpose of the CCIS Employment Verification form?

The CCIS Employment Verification form is designed to confirm an employee's employment status and income. This verification is necessary for determining eligibility for subsidized child care assistance. The information provided helps the Early Learning Resource Center (ELRC) assess the employee's qualifications for financial support.

Who is responsible for completing the form?

An authorized representative from the employer's organization must complete the CCIS Employment Verification form. It is important that this individual is not the employee requesting the verification. This ensures that the information provided is accurate and unbiased.

What specific information is required on the form?

The form requires several details, including:

  • Employer name and address
  • Employee's job title and employment start date
  • Hourly rate and gross pay
  • Average daily tips and pay frequency
  • A detailed work schedule, including days and hours worked
  • Information regarding any extended leave or temporary employment status

Completing all sections accurately is crucial for the verification process.

How should the work schedule be presented?

The work schedule must clearly outline the days and hours the employee works. It is essential to specify whether the hours are during A.M. or P.M. If the employee's schedule varies, a 4-week sample schedule should be provided. This helps to give a comprehensive view of the employee's work hours.

What if the employee does not receive paystubs?

If the employee does not receive paystubs, this should be indicated on the form. Employers can note alternative methods of payment, such as cash or online payment access. Accurate reporting of payment methods is necessary for the ELRC's assessment.

What happens if the employee is on extended leave?

If the employee is on extended leave, the employer must indicate this on the form. The effective dates of the leave and the anticipated return date should also be provided. This information is vital for understanding the employee's current employment status.

Where should the completed form be sent?

The completed CCIS Employment Verification form must be mailed directly to the Early Learning Resource Center (ELRC). It is important to ensure that the form is sent to the correct address to avoid delays in processing the employee's application for child care assistance.

Common mistakes

Filling out the CCIS Employment Verification form can be straightforward, but several common mistakes can complicate the process. One major error occurs when employers fail to provide accurate contact information. This includes the employer's telephone number and the address of employment. If the Early Learning Resource Center (ELRC) cannot reach the employer, it may delay the verification process, potentially affecting the employee's eligibility for subsidized child care.

Another frequent mistake is neglecting to specify whether the employee is newly hired. This question is crucial as it helps determine the employee's current status. If this section is left blank or answered incorrectly, it could lead to confusion and further inquiries, prolonging the verification process.

Many employers also overlook the importance of detailing the employee's work schedule. The form requires specific times and days worked, clearly indicating whether hours fall in the A.M. or P.M. Failing to provide a complete and accurate schedule can result in misunderstandings about the employee's availability and work hours.

Additionally, when reporting employment income, some employers mistakenly provide incomplete information. This includes omitting the gross pay or average daily tips. Such omissions can lead to complications in determining the employee's financial eligibility for assistance, ultimately affecting their ability to receive the necessary support.

Finally, employers often forget to sign and date the form. This step is essential, as it verifies that the information provided is accurate and authorized. Without a signature, the form may be considered incomplete, causing unnecessary delays in the employee's application for child care assistance.

Documents used along the form

When submitting the Ccis Employment Verification form, there are several other documents that may also be required. Each of these forms helps to provide a complete picture of the employee’s work situation and eligibility for assistance. Here’s a brief overview of these additional documents:

  • Pay Stubs: These are documents provided by the employer that show the employee’s earnings for each pay period. They detail gross pay, deductions, and net pay, helping verify income.
  • W-2 Form: This form is issued by the employer at the end of the tax year. It summarizes the employee's total earnings and taxes withheld, serving as a crucial income verification tool.
  • Job Offer Letter: This letter outlines the terms of employment, including job title, salary, and start date. It helps confirm the employee’s position within the company.
  • Tax Returns: Personal tax returns can provide a comprehensive view of an employee's income over the past year. They may be requested to verify additional income sources.
  • Direct Deposit Authorization Form: This document indicates the employee's choice to have their paycheck directly deposited into their bank account. It can help confirm employment and payment frequency.
  • Schedule of Hours: A detailed schedule showing the employee's work hours can clarify their availability and consistency in attendance, which is essential for verifying employment.

Providing these documents along with the Ccis Employment Verification form will help streamline the verification process. It ensures that all necessary information is available for review, making it easier for the Early Learning Resource Center to assess eligibility for subsidized child care.

Similar forms

The W-2 form is a document that employers use to report an employee's annual wages and the taxes withheld from their paycheck. Similar to the Ccis Employment Verification form, the W-2 requires the employer's identification information and details about the employee's earnings. Both forms aim to provide verification of employment status and income, which can be essential for various applications, including financial assistance programs.

The pay stub serves as a record of an employee's earnings for a specific pay period. Like the Ccis Employment Verification form, it includes information about the employee's gross pay, deductions, and net pay. Both documents help verify employment and income, making them useful for employees applying for loans, housing, or childcare assistance.

The I-9 form is used to verify an employee's identity and eligibility to work in the United States. While it focuses more on identity verification, it also collects employment information, such as job title and start date. Similar to the Ccis Employment Verification form, the I-9 must be completed by the employer and is essential for establishing employment status.

The 1099 form is issued to independent contractors and freelancers to report income earned outside of traditional employment. This document is comparable to the Ccis Employment Verification form in that it confirms income received by an individual. Both forms are important for individuals when applying for financial assistance or loans, as they provide proof of earnings.

A reference letter from an employer can serve as a personal recommendation for an employee. This letter often includes details about the employee's job title, responsibilities, and performance. Like the Ccis Employment Verification form, a reference letter can help verify employment history and is often requested during job applications or for financial assistance.

The employment contract outlines the terms of employment between an employer and an employee. It includes information about job title, salary, and work schedule. Similar to the Ccis Employment Verification form, the employment contract provides proof of employment and can be used to verify income and job status when applying for assistance programs.

The payroll summary report is a document that provides an overview of an employee's earnings over a specific period. This report includes details about hours worked, pay rates, and total earnings. Like the Ccis Employment Verification form, it serves to verify income and employment status, making it useful for applications requiring proof of financial stability.

The job offer letter is provided to a candidate upon acceptance of a job offer. It outlines the job title, salary, and start date. Similar to the Ccis Employment Verification form, the job offer letter confirms employment and can be used as documentation when applying for benefits or assistance programs.

The employment history form is a document that lists an individual's previous employment experiences. It typically includes job titles, dates of employment, and responsibilities. Like the Ccis Employment Verification form, this document provides verification of work history and can be essential for job applications or financial assistance requests.

Dos and Don'ts

When filling out the Ccis Employment Verification form, it is crucial to ensure accuracy and completeness. Here are six important dos and don’ts to keep in mind:

  • Do provide accurate employer information, including the employer's name and contact details.
  • Do specify the employee's job title and employment start date clearly.
  • Do indicate the employee's pay frequency and provide the correct income details.
  • Do ensure that the work schedule is detailed, including specific days and hours worked.
  • Don't leave any sections blank; incomplete forms may lead to delays in processing.
  • Don't forget to have an authorized company representative sign the form, not the employee.

Filling out this form accurately is essential for the employee's eligibility for subsidized child care. Take the time to review each section carefully before submission.

Misconceptions

Misconceptions about the Ccis Employment Verification Form can lead to confusion and delays in processing. Here are nine common misconceptions, along with clarifications for each.

  1. Only full-time employees need to complete the form.

    This is incorrect. The form is required for both full-time and part-time employees seeking subsidized child care assistance.

  2. The employee can fill out the form themselves.

    Actually, an authorized company representative must complete the form, not the employee. This ensures the accuracy and validity of the information provided.

  3. Providing a pay stub is sufficient.

    A pay stub alone is not enough. The form must be filled out in detail to verify employment status, income, and work schedule.

  4. It is optional to provide the employee's work schedule.

    In fact, providing a detailed work schedule is mandatory. This information helps determine eligibility for child care subsidies.

  5. The form can be submitted by the employee.

    The form must be mailed directly to the Early Learning Resource Center (ELRC) by the employer or an authorized representative.

  6. All sections of the form are optional.

    This is misleading. Certain sections, especially those regarding employment income and schedule, must be completed for the form to be valid.

  7. Only the employer's signature is needed.

    Both the employer's printed name and signature are required to confirm the authenticity of the information provided.

  8. Temporary employees do not need to complete the form.

    Temporary employees are also required to complete the form if they are seeking assistance for child care costs.

  9. The form is only for employees on leave.

    This is incorrect. The form is necessary for all employees applying for subsidized child care, regardless of their leave status.

Understanding these misconceptions can help streamline the employment verification process and ensure that employees receive the support they need.

Key takeaways

Filling out the CCIS Employment Verification form accurately is crucial for both employers and employees. Here are ten key takeaways to consider:

  • Employer Identification: Clearly provide the employer's name and address, as well as the Employer Identification Number (EIN).
  • Supervisor Information: Include the immediate supervisor's name and title for verification purposes.
  • Employee Authorization: Ensure the employee signs the form to authorize the release of their information.
  • Employment Details: Complete sections regarding the employee's job title, start date, and whether they are newly hired.
  • Income Information: Accurately report the employee's hourly rate, gross pay, and any average daily tips.
  • Pay Frequency: Specify how often the employee is paid (weekly, bi-weekly, etc.) to provide clarity on income.
  • Work Schedule: Detail the employee's work hours and days, noting whether they fall in the A.M. or P.M.
  • Extended Leave: Indicate if the employee is on any extended leave and provide relevant dates.
  • Temporary Employment: If applicable, clarify if the employee is a temporary hire and the last date of guaranteed employment.
  • Submission Protocol: The completed form must be mailed directly to the Early Learning Resource Center (ELRC) by an authorized company representative.

These points will help ensure that the form is filled out correctly, facilitating the verification process for subsidized child care eligibility.