Wage Verification Form

Information you will need

• REQUESTOR ONLY: What's your name?
• REQUESTOR ONLY: What's your phone number?
• REQUESTOR ONLY: What's your address?
• REQUESTOR ONLY: What's your email address?
• REQUESTOR ONLY: What's your fax number?
• EMPLOYEE ONLY: What's your name?
• EMPLOYER ONLY: What's the employee's job title?
• On what date did the employee start working for you?
• Is the employee currently on leave from work?
• What type of leave is the employee on?
• What's the employee's return date?
• How much does the employee earn from their hourly pay on average per month?
• How much does the employee earn from tips on average per month?
• What's the employee's pay period?
• Is the employee paid in cash?
• Do the employee's hours vary?
• How do the employee's hours vary?
• What's name of the employer or company that the employee works for?
• What's the employer's address?
• What's the employer's phone number?
• What's the employer's email address?
• What's your name?
• What's your title?
• How much does the employee earn from commissions on average per month?

…and 1 more field in the PDF.

Completed by the employer and the employee.

The form includes 2 signature lines.