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In the pursuit of supporting employees who require assistance in covering their child care costs, the CCIS Employment Verification Form plays a crucial role. This document serves as a bridge between employers and the Early Learning Resource Center (ELRC), enabling an accurate assessment of an employee's eligibility for subsidized child care programs. The form delves into various aspects of the employee's work life, requesting detailed information such as the employer's identification number, supervisor details, employee job title, income, pay frequency, and a comprehensive employment schedule. It also addresses scenarios of extended leave and temporary or seasonal employment to provide a full picture of the employee's work situation. In addition to requiring the employer's certification through signature, it emphasizes the importance of the employer undertaking this responsibility seriously by not delegating it to the employee in question. The intention is clear: to ensure that the information provided is precise and truthful, facilitating the ELRC's task of determining subsidy eligibility, thereby helping employees lessen the financial burden of child care.

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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 Attributes

Fact Description
Purpose of the Form This form is used to verify the employment details of an individual seeking assistance for childcare costs through the subsidized childcare program.
Authorization Required The employee must authorize the release of information by signing the form, allowing the Early Learning Resource Center (ELRC) to verify the details provided.
Information Required from Employers Employers need to fill in specific details including Employer Identification Number (EIN), address, telephone number, employee's job title, employment start date, income details, and work schedule.
Income Verification Details The form requires detailed income information such as hourly rate, gross pay, average daily tips, pay frequency, and if the employee receives paystubs or cash.
Work Schedule Documentation Employers must document the employee's schedule, including a 4-week sample schedule if the hours vary weekly, and note any extended leave or temporary/seasonal employment specifics.
Governing Law This form must be completed in accordance with Pennsylvania state laws, as it is issued by the Early Learning Resource Center (ELRC) Region 17 for Pennsylvania residents.

How to Fill Out Ccis Employment Verification

Filling out the CCIS Employment Verification form is a crucial step in confirming an employee's employment status and earnings for eligibility in subsidized child care programs. Employers must provide accurate and detailed information about the employee's work schedule, income, and employment status. This form serves as a means to ensure that the employee receives the proper subsidy for child care services. Here are the steps to accurately complete the form:

  1. Enter the employer's name and the place of employment at the top of the form.
  2. Fill out the immediate supervisor's name and title.
  3. The employee must print their name, sign the form, and date it to authorize the release and verification of the employment information provided.
  4. Under the section designated for employer completion, enter the Employer Identification Number (EIN) and the address of employment.
  5. Provide the employer's telephone number, including area code.
  6. Detail the employee information, including the job title, and indicate if the employee is newly hired by ticking the appropriate box (Yes or No).
  7. Specify the employment start date in the format MM/DD/YYYY.
  8. In the Employment Income section, fill in the hourly rate, gross pay, and average daily tips (if applicable), along with the next pay date and pay frequency (Weekly, Bi-Weekly, Twice a Month, or Monthly).
  9. Indicate whether the employee receives paystubs, is paid in cash, or has online access to pay information and provide the website if applicable.
  10. For the Employment Schedule, list the hours worked for each day over a four-week period, defining times as A.M. or P.M. If the schedule varies, a sample 4-week schedule must be provided with total hours worked per week clearly stated.
  11. If applicable, mark if the employee is on extended leave (such as maternity or disability leave), including the effective begin date and the date returned from such leave.
  12. Indicate if the employment is temporary or seasonal, providing the last date of guaranteed employment, the last day of work before break, and the expected date of return following the break, if applicable.
  13. Finally, an authorized company representative must print their name and job title, sign and date the form, acknowledging the information provided will be used to determine the employee’s eligibility for subsidized child care.

Once completed, this form should be mailed directly to the Early Learning Resource Center (ELRC) at the provided address. This process verifies the employment details necessary for the employee’s application for subsidized child care, a vital assistance for many families. Ensure all information is accurate and complete before submission to avoid delays.

More About Ccis Employment Verification

  1. What is the Ccis Employment Verification form?

    The Ccis Employment Verification form is a document designed to confirm an employee's employment details, including job title, employment status, schedule, income, and any extended leave periods. This form gets submitted to the Early Learning Resource Center (ELRC) to assess eligibility for subsidized child care programs. It is an essential step for employees seeking assistance with child care costs and requires detailed completion by a company representative, not the employee in question.

  2. Who should complete the Ccis Employment Verification form?

    An authorized company representative should fill out the Ccis Employment Verification form. It's crucial that the person completing the form takes care to provide accurate and detailed information regarding the employee's work schedule, income, and any potential extended leave or variations in work schedule. Employees cannot complete this form themselves; it must be an employer or representative of the employer to ensure the validity of the information provided.

  3. What information is needed to fill out the form?

    To accurately complete the form, several pieces of information are required, including the employer's identification number (EIN), address of employment, and employer’s contact number. In addition, detailed information about the employee's job title, start date, income details, and work schedule must be provided. If the employee’s work schedule varies, a 4-week sample schedule should be given. In cases of extended leave or seasonal employment, relevant dates must also be noted. All this information contributes to assessing the employee's eligibility for subsidized child care services accurately.

    • Employer and supervisor information
    • Employee identification and job details
    • Income and pay frequency
    • Detailed employment schedule
    • Extended leave and seasonal employment information
  4. How and where to submit the Ccis Employment Verification form?

    The completed Ccis Employment Verification form should be mailed directly to the Early Learning Resource Center (ELRC) at the address provided on the form. It's essential to ensure that the form is filled out comprehensively and accurately before submission to avoid any delays or issues in the verification process. The form details the specific ELRC region where it must be sent, including the street address, PO Box number, telephone and fax numbers, ensuring it reaches the correct department for the child care assistance application process.

Common mistakes

When filling out the CCIS Employment Verification Form, attentiveness to detail and precision in providing the requested information are imperative. However, individuals and employers occasionally encounter pitfalls. Here are eight common mistakes to be aware of:

  1. Not obtaining the employee’s authorization: Skipping the crucial step of having the employee sign and consent to the release of their information undermines the form's validity.
  2. Incomplete or incorrect employer details: Failing to accurately provide or fully complete employer information, such as the Employer Identification Number (EIN) or the full address, can cause processing delays.
  3. Omission of supervisor information: Neglecting to include immediate supervisor’s name and title can lead to difficulties in verifying employment details.
  4. Providing vague employment schedule: Not clearly specifying the work schedule, including the exact hours and whether they are AM or PM, especially if the schedule varies, can hinder the accurate assessment of eligibility for subsidized child care.
  5. Incorrect employment income details: Mistakes in reporting the hourly rate, gross pay, or misunderstanding the pay frequency options could lead to an inaccurate determination of child care subsidies.
  6. Forgetting to indicate employment status: Overlooking sections that require information on whether the employee is newly hired, on extended leave, or considered temporary or seasonal can lead to incomplete evaluation.
  7. Skipping sections relevant to pay method: Not indicating whether the employee receives paystubs, gets paid in cash, or has access to pay online can lead to incomplete financial documentation.
  8. Failure to accurately reflect changes in employment: Not providing information on the effective begin date of schedule changes, temporary assignments, or maternity leave can affect the subsidy determination process.

To ensure a smooth and efficient process in obtaining necessary subsidies for child care, both employees and employers should double-check the filled sections for accuracy and completeness. Offering clear, accurate information is key in assisting the Early Learning Resource Center (ELRC) in determining the correct subsidy eligibility, thus supporting families in their child care needs.

Documents used along the form

Completing the CCIS Employment Verification form is often a crucial step for employees seeking assistance for child care costs. However, to ensure a comprehensive view of an employee's financial and employment situation, additional forms and documents are commonly used alongside this verification form. Each of these documents plays a vital role in accurately determining eligibility and the level of assistance required.

  • W-2 Form: An annual tax document provided by employers that outlines the employee's total gross earnings, taxes withheld, and Social Security earnings. It's essential for verifying annual income.
  • Pay Stubs: These provide a breakdown of each paycheck received by the employee, including earnings, deductions, and taxes. Pay stubs are useful for verifying income and employment on a more immediate basis than annual forms.
  • I-9 Employment Eligibility Verification: A legal form used in the U.S. that documents that an employee is legally eligible to work in the country. This form confirms identity and employment authorization.
  • Employee Identification Number (EIN) Documentation: A document that verifies the employer's EIN, which is required on many employment and tax forms to identify the company.
  • Proof of Residency: Documents such as utility bills, a lease agreement, or a driver's license, affirming the employee's current address. This may be necessary for programs with location-based eligibility criteria.
  • Recent Tax Return: A copy of the most recent federal or state tax return can provide a comprehensive overview of an employee’s financial situation, supporting the income information provided.
  • Letter of Employment: A document from the employer confirming an employee's job title, salary, and status (full-time, part-time, temporary). It may also affirm the employee's start date and role within the company.
  • Benefit Verification Letter: If applicable, a letter from government agencies or insurance companies confirming the employee's receipt of benefits such as Social Security, disability, or unemployment benefits. This aids in providing a full picture of the employee's income sources.

Together, the CCIS Employment Verification form and these additional documents enable a thorough and accurate assessment of an employee’s eligibility for child care assistance programs. It's crucial for both employers and employees to be aware of these requirements to ensure the submission of a complete application, ultimately facilitating access to needed support.

Similar forms

  • Income Verification Form: Similar to the CCIS Employment Verification form, an Income Verification Form is used to authenticate an employee's earnings. However, it focuses primarily on the verification of income for various purposes such as loans and rental agreements, rather than child care eligibility.

  • Employee Background Check Authorization Form: This form also requires employee authorization and gathers personal information. Whereas the CCIS Form is used to verify employment and income for child care subsidies, the Background Check Form is used to verify an applicant's criminal history, credit history, and other personal details for employment purposes.

  • Payroll Deduction Authorization Form: Both this form and the CCIS Employment Verification form involve the employer's payroll department. While the CCIS form confirms employment details and income for child care subsidy purposes, the Payroll Deduction Authorization form allows employers to withhold a specific amount from an employee's paycheck for various reasons, such as retirement plans or health insurance premiums.

  • Work Schedule Form: Similar to the scheduling section of the CCIS form that outlines an employee's work hours, a Work Schedule Form specifies an employee's shift patterns. Both forms are utilized to establish or communicate the regular working hours of an employee, albeit for different end purposes.

  • Leave of Absence Request Form: This form shares similarities with the extended leave section of the CCIS form, where an employee's leave status (such as maternity or disability leave) is documented. Both forms formalize the process of requesting time away from work, though their implications for the employee's status or benefits may differ.

  • Job Offer Letter: A Job Offer Letter, much like the employment information section of the CCIS form, provides details about an employee’s job title, start date, and sometimes compensation. The key difference is the Job Offer Letter serves as an initial employment proposal, whereas the CCIS form verifies ongoing employment for child care purposes.

  • Employee Onboarding Checklist: The process documented by an Employee Onboarding Checklist and the CCIS Employment Verification form both involve the collection of crucial employment details during the hiring process. The former is typically used internally to ensure a new hire is properly integrated into a company, while the latter verifies employment for external child care subsidy determinations.

  • Wage and Hour Verification Form: This form is utilized to confirm an employee's compensation and work hours, similar to sections of the CCIS Form. However, it's typically used in compliance checks or labor dispute resolutions instead of child care subsidy applications.

  • Emergency Contact Form: While primarily focused on gathering contact information for use in emergencies, this form similarly requires employee authentication and documentation. Unlike the CCIS Employment Verification form, its primary function is for safety and emergency preparedness rather than verifying employment details for third-party services.

Dos and Don'ts

When completing the CCIS Employment Verification Form, there are specific steps to ensure the process is smooth and complies with the necessary guidelines to assist in determining eligibility for subsidized child care. It is crucial for both employers and employees to understand the do's and don'ts to avoid delays or issues in the eligibility process.

Do's:

  1. Ensure Accuracy: Double-check all the information provided for accuracy, including the employer identification number (EIN), employment income, schedule, and any other required details. Incorrect information can lead to delays in the verification process.
  2. Provide Complete Information: Fill out every section of the form that applies. If the schedule varies, include a 4-week sample schedule as requested. Incomplete forms may not be processed, resulting in a delay for determining eligibility.
  3. Sign and Date the Form: Make sure an authorized company representative signs and dates the form. The signature confirms the accuracy and authenticity of the information provided.
  4. Use clear and specific schedule times: Clearly indicate the hours worked as either A.M. or P.M. Vague or unclear entries can cause confusion and errors in processing the form.

Don'ts:

  1. Do Not Let the Employee Fill or Sign the Employer Section: An authorized company representative must complete and sign the part of the form dedicated to employer information. Allowing an employee to fill or sign this section could jeopardize the form’s validity.
  2. Avoid Guessing Information: Do not fill out any part of the form with guesses or estimations. If you're unsure about certain information, verify it before submission to ensure accuracy.
  3. Do Not Omit Dates and Signatures: Failing to provide required dates, such as employment start date or the date of completing the form, and forgetting to sign the document, may invalidate it.
  4. Do Not Delay Submission: Once completed, send the form directly to the Early Learning Resource Center (ELRC) without delay. Holding onto the form can delay the eligibility determination process for the employee.

Misconceptions

Understanding the CCIS Employment Verification Form is crucial for employers and employees alike. There are several misconceptions surrounding this document. Clearing these up is important to ensure that the process of verifying eligibility for subsidized child care programs is smooth and without errors.

Misconception 1: The employee can complete and submit the form themselves.

It is a common misunderstanding that the employee is responsible for filling out and submitting the CCIS Employment Verification Form. However, this task must be undertaken by an authorized company representative, ensuring that the information provided is accurate and officially endorsed by the employer.

Misconception 2: Detailed employment schedules are not necessary.

Some believe that a general outline of an employee's work hours is sufficient. In truth, the form requires specific details of the employee's work schedule, including exact hours worked and whether those hours occur in the A.M. or P.M. If the schedule varies, a four-week sample schedule must be provided.

Misconception 3: The form is only for full-time employees.

This misconception could lead to unnecessary exclusions of part-time, temporary, or seasonal employees from potential benefits. The CCIS Employment Verification Form applies to all employees, regardless of their employment status, as it includes sections specifically for temporary and seasonal work, as well as extended leave.

Misconception 4: Pay stubs or online pay access is not required information.

There might be an assumption that this form concentrates purely on schedule and gross pay. However, it clearly requests information regarding whether the employee receives pay stubs, gets paid in cash, or has access to pay information online. This detailed financial information is crucial for accurately determining program eligibility.

Misconception 5: Only current employment details are needed.

While current employment details are crucial, the form also seeks to understand future work commitments through sections on temporary or seasonal employment and expected dates of return from extended leaves. This forward-looking information helps ELRC make more informed decisions regarding subsidized child care eligibility.

In summary, employers play a pivotal role in accurately and completely filling out the CCIS Employment Verification Form. Understanding its requirements fully benefits both the employer and the employee, facilitating access to necessary support services effectively.

Key takeaways

Filling out the CCIS Employment Verification Form is an important process for employees seeking assistance with child care costs. Here are seven key takeaways to ensure the form is completed accurately and efficiently:

  • Authorization is required: Employees must sign the form to authorize the release of their employment information to the Early Learning Resource Center (ELRC). This step shows consent for verifying the information provided.
  • Employer's role is crucial: It is the responsibility of an authorized company representative, not the employee, to complete the form. This ensures the information is accurate and comes from a reliable source.
  • Specific details are needed: Employers need to provide detailed information, including the Employer Identification Number (EIN), employment address, and precise employment schedule. If the employee's schedule varies, a 4-week sample schedule must be provided.
  • Income information is essential: The form requires comprehensive details about the employee's income, such as their hourly rate, gross pay, and average daily tips. Pay frequency and the next pay date are also required to accurately assess the employee's financial situation.
  • Pay method should be indicated: Employers must specify whether the employee receives paystubs, is paid in cash, or has access to pay information online. These details help in verifying the pay information provided.
  • Consideration for special employment types: The form accommodates employees on extended leave (like maternity or disability leave) and those in temporary or seasonal positions by asking for relevant dates and schedules.
  • Accuracy is paramount: The information provided on the form is used to determine the employee’s eligibility for subsidized child care. Therefore, accurate and honest reporting is vital for a fair assessment.

Properly completing the CCIS Employment Verification Form is not just about following procedures. It's about ensuring that employees who need help with child care costs can receive the support they deserve. Employers and employees alike should treat the process with care and diligence.

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