Employment Verification Form for Employers

Employment Verification – Employer

Employee First Name *

Employee Middle Initial

Employee Last Name *

Employee Date of Birth (MM-DD-YYYY) *

Please use the calendar dropdown to select date.

Employer Business Name *

Employer Phone Number *

Employer Address

City

State

Zip

Zip 4

Name and Title of Person Completing Form *

Email Address *

Build Dakota Employee Title *

Description of Work *

Hours Worked per Week *

Employment Status *

Circumstances for Less Than Full-Time Work

Salary *

Please input value only – no dollar signs, periods, commas, or text.

Start Date (MM-DD-YYYY) *

Please use the calendar dropdown to select date.

End Date If Applicable (MM-DD-YYYY)

Please use the calendar dropdown to select date.

Human Resources Individual or Supervisor Name *

Today’s Date (MM-DD-YYYY) *

If you are human, leave this field blank.