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The CCIS Employment Verification Form serves a critical role in the process of verifying an employee's employment status, particularly for those seeking assistance with child care costs. This form requires essential details from both the employer and the employee, ensuring a comprehensive overview of the employee's work situation. Employers must provide their identification number, address, and contact information, along with specific details about the employee's job title, employment start date, and income. The form also includes sections for outlining the employee's work schedule, which must be detailed in terms of hours worked and whether these hours fall in the A.M. or P.M. Additionally, it addresses whether the employee is newly hired, on extended leave, or considered temporary or seasonal. By collecting this information, the Early Learning Resource Center (ELRC) can accurately assess eligibility for subsidized child care programs. The completion of this form is not merely a bureaucratic step; it is a vital process that impacts the financial stability of families relying on child care assistance.

Sample - Ccis Employment Verification Form

 

 

 

 

 

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

File Specs

Fact Name Details
Purpose The Ccis Employment Verification form is used to confirm an employee's job status and income for subsidized child care eligibility.
Completion Requirements This form must be filled out by an authorized company representative, not the employee themselves.
Employer Information Employers need to provide their identification number (EIN), address, and contact details on the form.
State Governing Law In Pennsylvania, the governing laws for this form are outlined in the Child Care Works program regulations.

Ccis Employment Verification - Usage Guidelines

After completing the Ccis Employment Verification form, it should be mailed directly to the Early Learning Resource Center (ELRC). Ensure that all sections are filled out accurately, as this information is crucial for determining the employee's eligibility for subsidized child care.

  1. Begin by entering the Employer Name/Place of Employment.
  2. Fill in the Immediate Supervisor’s Name and Immediate Supervisor’s Title.
  3. Provide the Employee’s Printed Name.
  4. Obtain the Employee’s Signature and the Date of signing.
  5. Complete the section labeled Employer Identification Number (EIN).
  6. Enter the Address of Employment.
  7. Fill in the Employer’s Telephone Number in the specified format.
  8. Provide the Employee’s Job Title.
  9. Indicate whether the employee is newly hired by selecting Yes or No.
  10. Enter the Employment Start Date in the specified format.
  11. Fill in the Hourly Rate, Gross Pay, and Average Daily Tips.
  12. Specify the Next Pay Date and select the Pay Frequency.
  13. Indicate how the employee receives pay by checking the appropriate options.
  14. Complete the Employment Schedule section, detailing the days and hours worked for each week.
  15. If applicable, provide the Effective Begin Date of Schedule Change.
  16. Indicate if the employee is on Extended Leave and provide relevant dates.
  17. State whether the employee is a Temporary Hire or Seasonal and provide necessary dates.
  18. Fill in the Employer’s Printed Name & Job Title.
  19. Obtain the Employer’s Signature and the Date of signing.

Your Questions, Answered

What is the purpose of the CCIS Employment Verification Form?

The CCIS Employment Verification Form is used to confirm an employee's job status and income. This information is essential for determining eligibility for subsidized child care assistance. Employers must complete this form to provide accurate details about the employee's employment situation.

Who is responsible for completing the form?

An authorized company representative, not the employee, must fill out the CCIS Employment Verification Form. This ensures that the information provided is accurate and verified by someone in a position of authority within the organization.

What specific information is required on the form?

The form requires various details, including the employer's name, employee's job title, employment start date, income details, and work schedule. It also asks about the employee's status, such as whether they are newly hired, on extended leave, or considered a temporary hire.

How should the work schedule be reported?

The work schedule must be detailed, indicating specific days and hours worked. Each hour must be marked as either A.M. or P.M. If the employee’s schedule varies, a 4-week sample schedule should be provided to give a clear picture of their typical hours.

What should be done if the employee is on extended leave?

If the employee is on extended leave, the form requires the employer to indicate this status and provide the effective dates of the leave and the return date. This information is important for assessing the employee's eligibility for child care assistance.

Where should the completed form be sent?

The completed CCIS Employment Verification Form must be mailed directly to the Early Learning Resource Center (ELRC). It is crucial to ensure that the form reaches the ELRC to facilitate the employee's application for subsidized child care.

What if there are questions about completing the form?

If there are any questions or uncertainties regarding how to fill out the form, employers are encouraged to contact the ELRC for guidance. They can provide assistance to ensure that the form is completed accurately and efficiently.

Common mistakes

  1. Incomplete Employer Information: Failing to provide all required details about the employer, such as the employer's name, address, or telephone number, can lead to delays in processing.

  2. Incorrect Employee Job Title: Listing an incorrect job title can misrepresent the employee's role, affecting eligibility for benefits.

  3. Missing Employment Dates: Not filling in the employment start date or the date of any extended leave can create confusion and hinder verification.

  4. Ambiguous Work Schedule: Providing a vague or incomplete work schedule without specifying A.M. or P.M. can lead to misunderstandings regarding the employee’s hours.

  5. Inaccurate Income Reporting: Errors in reporting the employee's hourly rate, gross pay, or average daily tips can result in incorrect assessments of eligibility.

  6. Failure to Sign: Not signing the form or having the authorized company representative sign can render the submission invalid.

  7. Ignoring Submission Instructions: Not mailing the form directly to the Early Learning Resource Center or failing to follow other specific submission guidelines can delay the process.

Documents used along the form

When applying for subsidized child care assistance, the CCIS Employment Verification form is just one piece of the puzzle. There are several other documents that may be required to support the application process. Each of these forms serves a specific purpose and helps verify the information provided by the employee. Here’s a list of common documents that may accompany the employment verification form:

  • Pay Stubs: These are records of the employee's earnings for each pay period. They provide detailed information about gross pay, deductions, and net pay, helping to verify income levels.
  • W-2 Forms: Issued by employers at the end of the year, these forms summarize an employee's total earnings and taxes withheld. They are useful for confirming annual income and employment status.
  • Tax Returns: Personal tax returns can provide a comprehensive view of an individual’s financial situation. They show total income from all sources and can help verify the employee's income claims.
  • Job Offer Letter: This document outlines the terms of employment, including job title, salary, and start date. It helps confirm the employee's current position and employment status.
  • Employer Reference Letter: A letter from the employer can provide additional context about the employee's role and performance. It can also confirm employment dates and job responsibilities.
  • Schedule of Hours: A document detailing the employee's work schedule can clarify the hours worked each week. This is especially important for verifying part-time employment or varying schedules.
  • Identification Documents: These can include a driver's license or social security card. They help verify the identity of the employee and ensure that the application is processed accurately.

Having these documents ready can streamline the verification process and help ensure that the employee receives the assistance they need. Each document plays a vital role in confirming employment status and income, which are crucial for determining eligibility for subsidized child care programs.

Similar forms

The W-2 form is a crucial document for employees and employers alike. It summarizes an employee's annual wages and the taxes withheld from their paycheck. Similar to the CCIS Employment Verification form, the W-2 provides essential information about an individual's employment status and income. Employers must complete the W-2 for each employee, ensuring accuracy in reporting earnings to the IRS. Both forms require the employer's identification and details about the employee's job title and income, making them vital for verifying employment and financial eligibility.

The I-9 form serves as another important employment verification document. It is used to confirm an employee's eligibility to work in the United States. Like the CCIS Employment Verification form, the I-9 requires information from both the employer and the employee. Employers must collect documents that prove the employee's identity and work authorization. This process ensures compliance with federal regulations, similar to how the CCIS form verifies employment for child care assistance eligibility.

The Paystub is a document that provides a detailed breakdown of an employee's earnings for a specific pay period. It includes information such as gross pay, deductions, and net pay. Like the CCIS Employment Verification form, paystubs offer insight into an employee's income and work schedule. They are often used to validate financial information when applying for loans or assistance programs. Both documents serve as proof of employment and income, supporting the employee’s claims in various applications.

The Employment Verification Letter is another document that shares similarities with the CCIS Employment Verification form. This letter, typically provided by an employer, confirms an employee's job title, salary, and length of employment. It is often requested by banks, landlords, or other entities requiring proof of employment. Both the Employment Verification Letter and the CCIS form serve the purpose of validating an employee's work status and income, though the letter may not require as detailed information about work hours or income frequency.

Dos and Don'ts

When filling out the CCIS Employment Verification form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of dos and don'ts to help you navigate this process effectively.

  • Do provide complete and accurate information for each section of the form.
  • Do ensure that the employer’s identification number (EIN) is included.
  • Do specify whether the employee is newly hired or not.
  • Do indicate the exact days and hours the employee works, noting A.M. or P.M.
  • Do submit the form directly to the Early Learning Resource Center (ELRC) as instructed.
  • Don't leave any required fields blank; incomplete forms can delay processing.
  • Don't provide vague descriptions of the employee’s schedule; be specific.
  • Don't forget to include the employer’s printed name and signature at the end of the form.
  • Don't allow the employee to fill out any sections that must be completed by the employer.

Misconceptions

Understanding the Ccis Employment Verification form is crucial for both employers and employees seeking assistance with child care costs. However, several misconceptions can lead to confusion. Here are ten common misunderstandings about this form:

  • The form is optional for employers. Some believe that completing the form is optional. In reality, it is a requirement for verifying an employee's eligibility for subsidized child care.
  • Any representative can fill out the form. It is often thought that any employee can complete the form. However, it must be filled out by an authorized company representative, not the employee themselves.
  • Only full-time employees need verification. Many assume that only full-time employees require this verification. In fact, part-time and temporary employees may also need their employment verified for child care assistance.
  • Pay stubs are not necessary. Some employers think they do not need to provide pay stubs. However, the form requires detailed information about the employee’s income, which may include pay stubs for accuracy.
  • All employment information is confidential. While personal information is protected, the employer must share specific details about the employee’s work schedule and income for verification purposes.
  • The form can be submitted by the employee. There is a misconception that employees can submit the form themselves. Instead, it must be mailed directly to the Early Learning Resource Center by the employer.
  • Only the employee's job title is needed. Some believe that only the job title is necessary for verification. In reality, comprehensive details about the employee's work schedule and income are required.
  • Variability in hours does not need to be reported. It is often thought that if an employee has a consistent schedule, they do not need to provide additional details. However, if the schedule varies, a four-week sample must be provided.
  • Extended leave does not affect eligibility. Many think that an employee on extended leave is unaffected by the verification process. However, this information is crucial in determining their eligibility for assistance.
  • Once submitted, the form cannot be changed. Some individuals believe that after submission, no changes can be made. In fact, if there are errors or updates, the employer can correct them by contacting the Early Learning Resource Center.

By addressing these misconceptions, employers and employees can navigate the verification process more effectively and ensure that assistance for child care costs is accurately assessed.

Key takeaways

When filling out and using the CCIS Employment Verification form, keep the following key points in mind:

  • Employer Information: Provide accurate details about the employer, including the name, address, and phone number.
  • Employee Authorization: The employee must sign the form, granting permission for the Early Learning Resource Center (ELRC) to verify the information.
  • Job Title and Status: Clearly indicate the employee's job title and whether they are newly hired.
  • Employment Schedule: Specify the days and hours the employee works, ensuring to denote A.M. or P.M. times.
  • Income Details: Include the employee's hourly rate, gross pay, and any average daily tips.
  • Extended Leave Information: If applicable, indicate whether the employee is on extended leave and provide relevant dates.
  • Submission Requirements: The completed form must be mailed directly to the ELRC by an authorized company representative, not the employee.

Accurate and complete information is crucial for determining the employee's eligibility for subsidized child care. Ensure all sections are filled out thoroughly to avoid delays.