CCIS Employment Verification Form – Fill Out and Use This PDF

The CCIS Employment Verification Form is a document used by the Child Care Information Services (CCIS) in Pennsylvania to verify a parent's employment status. The CCIS program provides financial assistance for child care to eligible families in Pennsylvania, and the employment verification form is used to determine a family's eligibility for this assistance.

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CCIS Employment Verification PDF Details

The CCIS VoE form requires the parent to provide information about their current employment, including their job title, employer's name and contact information, their work schedule, and their hourly wage or salary. The parent may also need to provide additional documentation, such as a pay stub or letter from their employer, to verify their employment status.

Here are several details you might want to look at before starting dealing with the ccis employment verification form.

Question	Answer
Form Name	Ccis Employment Verification Form
Form Length	2 pages
Fillable?	Yes
Fillable fields	116
Avg. time to fill out	23 min 46 sec
Other names	ccis e ployeverification form, ccis form printable, ccis employment verification form pa, ccis form

Form Preview Example

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

THE FOLLOWING SECTIONS MUST BE COMPLETED BY THEIR EMPLOYER

EMPLOYER IDENTIFICATION NUMBER (EIN):

ADDRESS OF EMPLOYMENT:

EMPLOYER’S TELEPHONE NUMBER:

(______) ______ - ____________

EMPLOYEE’S JOB TITLE:

Is the employee newly hired?

EMPLOYMENT START DATE:

______ / ______ / ____________

AVERAGE DAILY TIPS:

___ / ___ / ______

Twice a Month (24 pays/year)

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 sample schedule.

from_________ a.m./p.m. to_________

TOTAL # HOURS/WEEK: _________________________

from_________ a.m./p.m. to_________

TOTAL # HOURS/WEEK: _________________________

from_________ a.m./p.m. to_________

TOTAL # HOURS/WEEK: _________________________

from_________ a.m./p.m. to_________

TOTAL # HOURS/WEEK: _________________________

Effective begin date of schedule change:

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

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

Date returned from extended leave: ___ / ___ / ______

Is the employee considered to be a temporary hire?

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 employee’s eligibility for

subsidized child care.

EMPLOYER’S PRINTED NAME & JOB TITLE

Employment Verification Form

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 sample schedule. You do not need to give a 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

1430 DeKalb Street

(610) or (800) Fax (610)

How to Edit Ccis Employment Verification Form Online for Free

The ccis employment verification completing course of action is quick. Our editor enables you to use any PDF form.

Step 1: Hit the orange button "Get Form Here" on the website page.

Step 2: When you have accessed the ccis employment verification editing page you can see the different actions you may conduct relating to your template at the top menu.

To complete the document, provide the details the application will ask you to for each of the next areas:

ccis employment verification form pa empty fields to fill in

Fill in the Mon, from ampm to ampm, Mon, from ampm to ampm, Mon, from ampm to ampm, Mon, from ampm to ampm, Tues from ampm to ampm, Tues from ampm to ampm, Tues from ampm to ampm, Tues from ampm to ampm, Wed, from ampm to ampm, and Wed fields with any data that can be asked by the application.

Completing ccis employment verification form pa stage 2

You will have to give specific particulars inside the segment An authorized COMPANY, We must have an accurate record of, Thank you for your time and, and ELRC.

Finishing ccis employment verification form pa step 3

Step 3: Click the button "Done". The PDF form is available to be transferred. You can save it to your device or send it by email.

Step 4: Make sure to keep away from potential issues by generating no less than two copies of the form.