Appendix J - Employment Verification Form for Housing Qualification

To submit this form, you can send it via email to the specified rental community email address, fax it to the provided fax number, use the online submission form if available, or mail it to the rental community's physical address listed on the form. Ensure to submit the form before the deadline to avoid any processing delays. It's advised to keep a copy of the submitted form for your records.

Important dates for this form in 2024 and 2025 include the yearly recertification deadlines for rental community residents, which are typically set by the housing authority or property management. Ensure to check with your rental community for specific submission deadlines.

The purpose of this Employment Verification Form is to verify the employment status and income of individuals applying for residency or undergoing annual recertification in rental communities. This form helps rental communities determine eligibility for housing programs that require income documentation. By collecting accurate employment information, rental communities can ensure compliance with funding requirements and maintain proper records for housing assistance programs.

• 1. Date: The current date when the form is being filled out.
• 2. Applicant/Resident Name: The full name of the individual applying for residency or recertifying.
• 3. Development Name: The name of the rental community where the applicant/resident is seeking residency.
• 4. Unit Number/Identification: The specific unit number or identification for the applicant/resident's housing.
• 5. Employer Name and Address: The name and address of the applicant/resident's employer.
• 6. Rental Community Address: The address of the rental community to which the form should be returned.
• 7. Signature and Social Security #: The applicant/resident's signature and social security number for authorization.
• 8. Employee Name: The name of the employee whose employment is being verified.
• 9. Job Title: The job title of the employee.
• 10. Presently Employed?: Indicates whether the employee is currently employed.
• 11. Date First Employed: The date when the employee started their current job.
• 12. Last Date Employed: The last date the employee was employed, if applicable.
• 13. Current Wages/Salary: The employee's current wages or salary, and the payment frequency (hourly, weekly, etc.).
• 14. Average # regular hours per week: The average number of regular work hours per week for the employee.
• 15. Overtime Rate: The employee's overtime rate per hour and average overtime hours per week.
• 16. Shift Differential Rate: The employee's shift differential rate per hour and average shift differential hours per week.
• 17. Commissions, tips, bonuses: The amount and frequency of any commissions, tips, or bonuses earned by the employee.
• 18. Anticipated change in rate of pay: Any anticipated changes in the employee's rate of pay within the next 12 months.
• 19. Work seasonal or sporadic: Indicates if the employee's work is seasonal or sporadic, including layoff periods.
• 20. Additional Remarks: Additional remarks about the employee's employment.
• 21. Effective Date: The effective date of the information provided.
• 22. Employer Certification: Certification by the employer that the provided information is true and complete, including employer's signature, printed name, title, firm name, and telephone number.

Failing to submit this form can result in being deemed ineligible for residency or losing current housing eligibility. It's important to complete and submit the form accurately and on time.

• Ineligibility for Residency: Without this form, applicants may be deemed ineligible for the rental community.
• Loss of Current Housing: Current residents may lose their eligibility for housing without yearly recertification.
• Delayed Processing: Failing to submit the form can delay the processing of residency applications.

• 1. Applying for Residency: Use this form when first applying to live in a rental community.
• 2. Annual Recertification: Use this form for yearly income recertification required by your rental community.
• 3. Income Verification: Use this form to verify income for housing assistance programs.