Ccis Employment Verification Template Access Ccis Employment Verification Editor Now

Ccis Employment Verification Template

The Ccis Employment Verification form is a crucial document designed to verify employment details for employees seeking assistance with child care costs through the Early Learning Resource Center (ELRC). It ensures a thorough account of employment, including job title, income, schedule, and the possibility of extended leave or temporary employment status, by requiring an employer’s direct input. For accurate assistance in completing this form, click the button below.

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Table of Contents

The Ccis Employment Verification form is a crucial document designed to facilitate the assessment of an employee’s eligibility for subsidized child care programs. It requires detailed information from employers about their employees' work situation, including the employer's name, supervisor details, and specifics about the employee's job title, start date, pay, and work schedule. Employers are asked to provide a clear picture of the income and work hours of the employee, distinguishing between regular pay, tips, and the frequency of paychecks. For accurate scheduling information, a four-week sample schedule may be required to capture any variations in work hours. Additionally, the form touches on scenarios such as extended leave and temporary or seasonal employment to understand the employee's work status fully. Employers play a significant role in this process by authorizing and submitting this information to the Early Learning Resource Center (ELRC), which uses the details to determine the employee’s eligibility for child care cost assistance. This form not only underlines the importance of accurate employment verification in supporting child care assistance programs but also emphasizes the collaborative effort between employers, employees, and social support systems in ensuring that working parents have the necessary support for their child care needs.

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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

Form Breakdown

Fact Detail
Purpose of the Form Used to confirm an employee's employment status and income to assess eligibility for subsidized child care.
Who Completes the Form It must be filled out by an authorized company representative, not the employee requesting child care assistance.
Required Information Includes employer and supervisor details, employee job title, income, schedule, and indicates whether the employment is temporary or seasonal.
Submission Address The completed form is sent directly to the Early Learning Resource Center (ELRC) Region 17.
Governing Region Specific for use in Pennsylvania, as it is to be submitted to ELRC Region 17.

Guidelines on Filling in Ccis Employment Verification

When an employee seeks financial help for child care costs, verification of their employment status and schedule is required. This process involves accurately filling out the Employment Verification Form and mailing it directly to the Early Learning Resource Center (ELRC). The form gathers essential details about the employee's job title, employment duration, income, and work schedule to aid in determining eligibility for subsidized child care programs. Employers or their authorized representatives are responsible for providing this information. Ensuring that the details are specific, clear, and complete is crucial for a smooth verification process.

  1. Employer Information: Start by entering the EMPLOYER NAME/PLACE OF EMPLOYMENT, the IMMEDIATE SUPERVISOR'S NAME, and their TITLE at the top of the form.
  2. Employee Authorization: The employee must print their name, sign, and date the form to authorize the release and verification of the information provided.
  3. Employer Identification Number (EIN): Fill in the employer's EIN to ensure accurate identification and record-keeping.
  4. Address and Contact Information: Provide the ADDRESS OF EMPLOYMENT and the EMPLOYER'S TELEPHONE NUMBER, including the area code.
  5. Employee Details: Under the section labeled EMPLOYEE INFORMATION, enter the employee's job title. Mark whether the employee is newly hired and provide the EMPLOYMENT START DATE.
  6. Income Information: Specify the employee's HOURLY RATE, GROSS PAY, and AVERAGE DAILY TIPS, if applicable. Also, note the NEXT PAY DATE and select the PAY FREQUENCY.
  7. Pay Documentation: Indicate whether the employee receives paystubs, does NOT receive paystubs, receives pay in CASH, or has access to pay online. If online pay information is available, provide the website.
  8. Employment Schedule: Detail the employee's work schedule for a four-week period, including the total number of hours worked each week. If the schedule varies, provide a sample schedule that reflects this variability.
  9. Extended Leave and Temporary Employment: Indicate if the employee is on extended leave (e.g., maternity, disability) and provide relevant dates. Also, specify if the employment is temporary or seasonal and include the applicable dates.
  10. Employer Verification: Lastly, the form must be completed with the EMPLOYER'S PRINTED NAME & JOB TITLE, EMPLOYER'S SIGNATURE, and the DATE it was filled out.

Once the form is completed, it is essential to mail it directly to the designated ELRC as indicated on the form. This step is vital for the timely processing of the employee's application for subsidized child care assistance. Employers who require assistance or have questions about completing the form should not hesitate to contact the ELRC for guidance.

Learn More on Ccis Employment Verification

What is the purpose of the CCIS Employment Verification Form?

The CCIS Employment Verification Form is designed to authenticate an employee's job status and details for the Early Learning Resource Center (ELRC) primarily to establish eligibility for subsidized child care programs. It serves as a formal request to verify employment information including job title, income, schedule, and if the employment is temporary or seasonal. By accurately completing and submitting this form, employers assist their employees in potentially securing financial aid for child care costs, enabling them to continue working.

Who is required to complete the CCIS Employment Verification Form?

Completion of the CCIS Employment Verification Form must be carried out by an authorized company representative, not the employee who is requesting assistance for child care costs. This representative is tasked with providing detailed information regarding the employee's work schedule, income, and the nature of their employment (e.g., temporary, seasonal, or on extended leave). It's critical that the information given is accurate and comprehensive, as it directly impacts the employee's eligibility for the child care subsidy.

What specific information needs to be provided on the form?

  • Employer's name, address, and Employer Identification Number (EIN).
  • Immediate supervisor's name and title.
  • Employee's job title, start date, income details, pay frequency, and whether the employment is new.
  • Detailed work schedule for a typical four-week period, or if the schedule varies, a four-week sample schedule should be provided instead.
  • Information on whether the employee receives paystubs, is paid in cash, or has access to pay information online.
  • Status on extended leave or categorization as a temporary or seasonal employee, if applicable.

Where and how should the completed form be submitted?

The completed CCIS Employment Verification Form must be mailed directly to the Early Learning Resource Center (ELRC) at the address provided on the form itself. It is of utmost importance that the form is sent from the employer's address and not by the employee seeking the child care subsidy. This procedure ensures the confidentiality and integrity of the verification process. The address for submission is: Early Learning Resource Center Region 17, PO Box 311, 1430 DeKalb Street, Norristown, PA 19404-0311. Additionally, for queries or further clarification, employers can contact the ELRC via the telephone numbers or fax number listed on the form.

Common mistakes

Filling out the CCIS Employment Verification form accurately is critical for employees seeking assistance with child care costs. However, common mistakes can hinder the process. Here are 10 errors often made when completing this form:

  1. Not providing specific details for the employment schedule, including exact hours worked each day designated as A.M. or P.M.
  2. Forgetting to indicate whether the employee is a new hire, which can be crucial information for the ELRC to process the application appropriately.
  3. Leaving the section regarding extended leave blank, even when applicable, such as maternity or disability leave, that could affect child care needs.
  4. Incorrectly reporting or not reporting at all the gross pay, hourly rate, and average daily tips, leading to inaccuracies in determining eligibility for subsidized child care.
  5. Omitting the next pay date and pay frequency, which helps the ELRC understand the employee’s pay cycle and better assess their financial situation.
  6. Failing to check the appropriate boxes related to how the employee receives their paystubs (or doesn't), or if they receive pay in cash, which are important details for verifying income.
  7. Not correctly identifying the employer's contact information, including the address of employment and employer’s telephone number, complicating the verification process.
  8. Omitting or inaccurately providing the Employer Identification Number (EIN), a critical piece of information needed for employment verification.
  9. Leaving the temporary/seasonal employment section incomplete, including not specifying the last guaranteed date of employment for temporary workers or expected return dates for seasonal employees.
  10. Failure to have the form completed by an authorized company representative, meaning someone other than the employee, as this could result in the form being returned or not processed.

It's essential for both employees and employers to review the CCIS Employment Verification form thoroughly before submission, ensuring all required information is accurate and complete. This attention to detail will help avoid delays or issues with the application for subsidized child care assistance.

Documents used along the form

When completing the Child Care Information Services (CCIS) Employment Verification form, it's often not the only document required. Numerous other forms and documents are frequently used in conjunction to provide a comprehensive view of an employee's employment status, income, and eligibility for programs such as subsidized child care. Understanding these related documents can help streamline the application process and ensure that all necessary information is accurately conveyed.

  • W-2 Form: This vital tax document outlines an employee's annual wages and the amount of taxes withheld from their paycheck. It's usually required to verify income for the previous year.
  • Pay Stubs: Recent pay stubs provide proof of current employment and income. They are essential for verifying the employee's pay frequency, gross pay, and deductions.
  • Employer Letter: A letter from the employer can offer additional verification of employment, especially if it clarifies the nature of the employment (e.g., temporary, seasonal) and the expected duration of the job.
  • Form I-9: This form is used for verifying the identity and employment authorization of individuals hired for employment in the United States. It might be requested to ensure that an employee is legally permitted to work.
  • Leave of Absence Documentation: If an employee has taken a leave of absence for reasons such as maternity or disability leave, documentation might be necessary to show the start and end dates of the leave.
  • Income Tax Return: For self-employed individuals, a copy of the most recent income tax return might be required to verify income and employment.
  • Bank Statements: These can serve as supplementary proof of income, especially for employees who receive direct deposits or for those who are self-employed.
  • Schedule Change Request Form: If an employee's schedule varies significantly or has recently changed, a form requesting and documenting the change may need to be submitted alongside the Employment Verification form.

Compiling these documents together with the CCIS Employment Verification form requires careful attention to detail and thoroughness. Each piece of documentation serves its specific purpose, from establishing identity and legal work status to providing a detailed account of income and employment schedules. Accurate and timely submission of these documents not only facilitates the verification process but also helps ensure that the assistance goes to those who truly need it. As such, employers and employees must work collaboratively to gather and submit all required information to support their application for subsidized child care programs.

Similar forms

  • The W-4 form, used for federal tax withholding, is similar as it also requires personal and employment information to be filled out by the employee and is used to inform financial determinations, in this case, tax withholding rates.

  • The I-9 Employment Eligibility Verification form parallels this document since it is filled out by both the employee and the employer to verify the employee's legal eligibility to work in the United States, involving the verification of worker's personal and employment details.

  • Payroll Direct Deposit Authorization form shares similarities because it includes employee personal information, employment details, and requires authorization to process employment-related financial transactions, focusing on the disbursement of salaries.

  • The Background Check Authorization form can be seen as similar because it requires the employee’s consent for the employer to perform a background check, touching on the need for employee information verification for employment purposes.

  • Employee's Withholding Certificate for State Taxes (varies by state, e.g., California Form DE 4), like the CCIS form, needs employment information and personal details to calculate correct state tax withholdings, evidencing the interconnectedness of employment and financial considerations.

  • Benefits Enrollment form resembles the CCIS form as both require employee information and involve choices that affect financial aspects of employment, such as health insurance or retirement savings, which impact the employee's compensation package.

  • The Employment Contract, providing comprehensive details of the employment arrangement including job responsibilities, salary, and work schedule, is akin to the CCIS form in its requirement for detailed employment information to establish the terms of the employment relationship.

  • Request for Leave of Absence form correlates with the section on extended leave in the CCIS form, as both entail providing employment details and acquiring authorization related to changes in an employee’s work schedule due to leave.

  • The Job Application form is similar to the extent that it gathers preliminary employment information from candidates, which, if successful, becomes foundational to further employment verification and documentation processes.

  • The Employee Emergency Information form, while more focused on personal safety, draws parallels with the necessity for employee personal details and the employer's acknowledgement and verification of these details within the organizational context.

Dos and Don'ts

When you are filling out the CCIS Employment Verification form, it's crucial to get it right. Below are 10 tips - five things you should do and five things you shouldn't do - to help guide you through the process.

Do:
  • Verify all information before submission: Ensure that all details are accurate, including employer identification numbers, schedules, and pay rates.
  • Provide clear and defined work schedules: Indicate whether work hours are in the morning (A.M.) or afternoon (P.M.), and provide a 4-week sample schedule if the employee’s work hours vary.
  • Include all required signatures: The form requires signatures from both the employee and an authorized company representative to verify the information provided.
  • Pay attention to employment status: Accurately indicate whether the employee is newly hired, temporary, seasonal, or on extended leave, and provide corresponding dates as required.
  • Contact ELRC for any clarifications: If you have questions or uncertainties about filling out the form, reaching out to the Early Learning Resource Center (ELRC) can provide guidance.
Don't:
  • Leave sections incomplete: Failing to provide all the required information might lead to delays or the inability to process the application for subsidized child care correctly.
  • Guess on details: Providing incorrect information, whether it’s the address of employment, employment income, or employment schedule, can significantly impact the employee’s eligibility.
  • Let the employee complete the employer section: The form specifies that an authorized company representative must fill out certain sections to ensure accuracy and prevent fraud.
  • Omit income details: Whether it's the hourly rate, gross pay, or average daily tips, every piece of financial information helps in determining the eligibility for subsidized child care.
  • Forget to update the form for schedule changes: If there are any changes to the employee's work schedule or status after the submission, ensure to communicate this to the ELRC promptly.

Misconceptions

There are several misconceptions regarding the CCIS Employment Verification Form. Understanding these can help both employers and employees ensure the accurate and efficient processing of subsidized child care assistance applications.

  • Misconception #1: Employees can fill out and submit the form themselves.

    It's essential to understand that this form must be completed by an authorized company representative, not by the employee who is applying for subsidized child care assistance. This ensures that all information regarding employment and income is verified and accurate.

  • Misconception #2: Detailed employment schedules are only needed for employees with varying hours.

    While there's a provision to provide a 4-week sample schedule for employees whose work hours vary, it's crucial for employers to provide clear and specific schedules for all employees. This includes defining hours as A.M. or P.M. and providing an effective date for any schedule changes.

  • Misconception #3: The form is only for confirming an employee's current position and salary.

    Beyond basic employment verification, this form is used to assess the employment stability and income consistency of an applicant for subsidized child care. It includes sections on employment start date, pay frequency, and whether the employee is permanent or temporary, which are all critical for determining eligibility.

  • Misconception #4: Any employer can sign the form.

    Not just any employer representative can sign off on this form — it must be an authorized company representative. This often means someone in a management or human resources position who has direct knowledge of the employee's work schedule, compensation, and employment status.

It's important for employers to carefully read and accurately complete the CCIS Employment Verification Form to support their employees in accessing necessary child care services. Comprehensive and precise information helps streamline the process for everyone involved.

Key takeaways

Filling out the CCIS Employment Verification Form accurately is crucial for employees seeking assistance with child care costs through subsidized programs. Here are key takeaways for employers to consider:

  • It's important to give complete and detailed information about the employee’s work schedule, including specific hours and whether they occur in the A.M. or P.M. This detail is essential for determining the employee's eligibility for child care assistance.
  • Employers must include detailed employment income information, such as hourly rates, gross pay, average daily tips (if applicable), and pay frequency. This financial information impacts the assistance for which the employee may qualify.
  • The form requires an employer signature and clearly states that it must be completed by an authorized company representative, not the employee. This ensures the accuracy and integrity of the provided information.
  • If an employee’s work schedule varies, employers are asked to provide a 4-week sample schedule. This helps the Early Learning Resource Center (ELRC) understand the average hours the employee works and better assesses their need for child care assistance.

By carefully completing the CCIS Employment Verification Form, employers play a significant role in supporting their employees' access to affordable child care options. This not only benefits the employee but can also improve workplace morale and employee retention by addressing one of the critical needs of working parents.

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