The CCIS Employment Verification Form is a document used to confirm an employee's job status and income, primarily for the purpose of determining eligibility for subsidized child care assistance. This form requires detailed information from both the employer and the employee, including work schedules, pay rates, and employment duration. Completing this form accurately is essential for employees seeking financial support for child care, so be sure to fill it out by clicking the button below.
The CCIS Employment Verification Form plays a crucial role in determining an employee's eligibility for subsidized child care assistance. This form requires specific information from both the employee and the employer. Essential details include the employer's name, address, and contact information, as well as the employee's job title and employment start date. The form also asks for the employee's income, including hourly rates and gross pay, along with a breakdown of their work schedule. Employers must indicate whether the employee is newly hired, on extended leave, or considered temporary or seasonal. A clear record of hours worked, specified in either A.M. or P.M., is vital for accurate verification. The completion of this form is mandatory and must be submitted directly to the Early Learning Resource Center (ELRC) by an authorized company representative. This process ensures that the information provided is reliable and helps streamline access to necessary child care support.
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.
Wed.
Thur.
Fri.
Sat.
Sun.
TOTAL # HOURS/WEEK: _________________________
WEEK TWO
WEEK THREE
WEEK FOUR
Effective begin date of schedule change:
EXTENDED LEAVE
Is the employee on extended leave (maternity, disability, etc.)?
Effective begin date of extended leave: ___ / ___ / ______
Date returned from extended leave: ___ / ___ / ______
TEMPORARY/SEASONAL EMPLOYMENT
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 above-named employee’s eligibility for
subsidized child care.
EMPLOYER’S PRINTED NAME & JOB TITLE
EMPLOYER’S SIGNATURE
CY 925 6/19
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
Completing the Ccis Employment Verification form is a straightforward process. This form is essential for verifying employment details, which will be used to assess eligibility for subsidized child care. Follow the steps below to ensure accurate and complete information is provided.
Once completed, the form must be mailed directly to the Early Learning Resource Center (ELRC). Ensure all sections are filled out accurately to avoid delays in processing the employee's request for subsidized child care assistance.
What is the purpose of the CCIS Employment Verification Form?
The CCIS Employment Verification Form is used to confirm an employee's job details and income. This information helps determine if the employee qualifies for subsidized child care assistance through the Early Learning Resource Center (ELRC).
Who needs to complete the form?
An authorized company representative, not the employee, must fill out the form. This ensures that the information provided is accurate and verified by someone in a position of authority.
What information is required from the employer?
The employer must provide details such as the employer's name, address, phone number, and the employee's job title. They also need to include the employee's income, work schedule, and any information about extended leave or temporary employment status.
How should the work schedule be reported?
The work schedule should be detailed, indicating specific days and hours worked. If the employee's hours vary, a four-week sample schedule is required. It’s important to specify whether the hours are in the A.M. or P.M.
What if the employee does not receive paystubs?
If the employee does not receive paystubs, this should be clearly indicated on the form. The employer can also mention if the employee receives pay in cash or has access to online pay information.
What happens if the employee is on extended leave?
If the employee is on extended leave, the employer must indicate this on the form. They should provide the effective dates of the leave and the date the employee is expected to return to work.
Is there a specific format for reporting income?
Yes, the employer must report the employee's hourly rate, gross pay, and any average daily tips. This information helps establish the employee's financial situation for the subsidized child care program.
What if the employee is a temporary or seasonal hire?
The employer should indicate if the employee is temporary or seasonal. They must provide the last date of guaranteed employment for temporary hires or the last day of work before a break for seasonal employees, along with the expected return date.
How should the completed form be submitted?
The completed form must be mailed directly to the Early Learning Resource Center (ELRC). It should not be returned to the employee. The ELRC's contact information is provided on the form for any questions.
What if I have more questions about the form?
If you have questions about completing the form, you can contact the ELRC directly. Their phone number is (610) 278-3707 or (800) 281-1116. They can provide guidance and assistance as needed.
Filling out the CCIS Employment Verification form can be straightforward, but there are common mistakes that can lead to delays or complications. One frequent error is not providing the employer identification number (EIN). This number is essential for proper identification and processing. Without it, the form may be considered incomplete.
Another common mistake is failing to include the immediate supervisor's name and title. This information helps verify the employee's position and ensures that the verification process is accurate. Omitting this detail can lead to unnecessary back-and-forth communication.
Many people also forget to indicate whether the employee is newly hired. This information is crucial for the Early Learning Resource Center (ELRC) to assess eligibility for assistance. If this section is left blank, it may cause delays in processing the application.
Inaccuracies in the employment schedule are another area where mistakes often occur. It is vital to specify the days and hours the employee works clearly. If the schedule varies, providing a four-week sample is necessary. Incomplete or vague entries can result in confusion and further inquiries.
Some individuals neglect to clarify the pay frequency and income details. This includes the hourly rate, gross pay, and average daily tips. Missing or incorrect figures can complicate the verification process and may lead to misunderstandings regarding the employee's financial situation.
Another oversight involves the extended leave section. Employers must indicate if the employee is on extended leave and provide the relevant dates. Failing to do so can hinder the assessment of the employee's eligibility for child care assistance.
Lastly, the form must be signed by an authorized company representative, not the employee. This is a critical requirement. If the signature is missing or incorrect, the form will not be accepted, causing delays in the assistance process. Attention to detail is essential when completing this form to ensure a smooth verification process.
The CCIS Employment Verification form is an essential document used to confirm an employee's job status and income for child care assistance programs. Alongside this form, several other documents may be required to provide a comprehensive view of the employee's situation. Below is a list of commonly associated forms and documents.
Collecting these documents, along with the CCIS Employment Verification form, ensures a complete and accurate assessment of an employee's eligibility for subsidized child care. It is important to maintain clear records for both the employee and employer to facilitate the verification process.
When filling out the CCIS Employment Verification form, it's essential to follow certain guidelines to ensure accuracy and compliance. Here are five things you should and shouldn't do:
Understanding the CCIS Employment Verification Form can be crucial for both employers and employees. However, several misconceptions can lead to confusion. Here’s a breakdown of six common misunderstandings:
By clarifying these misconceptions, both employers and employees can navigate the CCIS Employment Verification Form more effectively. Understanding the requirements ensures a smoother process for everyone involved.
When filling out the CCIS Employment Verification form, there are several important points to keep in mind. Here’s a list of key takeaways to ensure a smooth process:
By keeping these points in mind, you can help ensure that the employment verification process goes smoothly and efficiently.