Homepage Fill in Your Texas Employment Verification Template
Table of Contents

The Texas Employment Verification form serves a crucial role in the process of confirming an individual's employment status, especially for those applying for state benefits. This form is designed for employers to provide essential information regarding their current or former employees. Key details required include the employee's name, address, and Social Security number, which the employee must consent to share. Employers are tasked with completing various sections, such as the employee's job type, rate of pay, and employment duration. They must also report on additional compensation like bonuses and commissions, which can be important for assessing eligibility for state benefits. The form includes instructions for employers on how to return the completed document, whether by mailing, faxing, or handing it back to the employee. Furthermore, it highlights the potential tax benefits for employers who hire individuals receiving certain state assistance. Overall, this form is an essential tool in the intersection of employment verification and state welfare programs, ensuring that accurate information is exchanged to facilitate support for individuals in need.

Sample - Texas Employment Verification Form

Name and Address

Date

Need help? Call 2-1-1 or 877-541-7905.

Fax: 877-447-2839

Mail:

Texas Health and Human Services Commission

P O BOX 149027

Austin, Texas 78714-9027

If you are deaf, hard of hearing, or speech impaired, call 7-1-1 or 800-735-2989. All numbers are free to call.

Case Name

Case No.

This form is for your employer. They need to fill out the form and return it by. You must agree to let them give facts about you.

Fill Out and Sign This Agreement

I,

 

(print your name) allow HHSC to give my Social Security number (SSN) to the employer listed on this form.

 

 

 

My SSN can be used to get facts about my employment. I also allow the employer listed on this form to give facts asked on this form to HHSC.

Signature

Date

Employer – Your Help Is Needed

Employee or Former Employee

Social Security No.

We need proof that the following person is or was your employee.

Some employers might get tax refunds or tax credits for hiring people who get certain state benefits.

To learn more, go to TexasWorkforce.org/wotc or email the Texas Workforce Commission at [email protected].

Employer please follow these steps.

This person lives in a home in which someone is applying for state benefits. We need to know the amount of money this person makes or made from this job.

1.Please fill out the “Proof of Employment” form on the next page.

2.If a question doesn't apply, mark it with "N/A."

3.Return the form:

To send this back to us, you can either:

(a)give it to the employee listed above,

(b)mail it in the pre-paid envelope, or (c) fax it to 877-447-2839.

Form H1028 / 07-2022

Employment Verification

Form H1028

Page 2 / 07-2022-E

Proof of employment to be filled out by the employer.

Company or Employer

Address (Street, City, State, ZIP code)

Employee Name (as shown on your records)

Employee Address (Street, City, State, ZIP Code – as shown on your records)

Is (or was) this person employed by you?

If yes, what type of job?

 

 

Yes

No

Full Time

Part Time

Permanent

Temporary

If no: Stop here – sign and date the bottom of this form and return it.

If yes: Answer all the questions below. If a question doesn’t apply, write “N/A".

Rate of Pay

Per Day

Per Week

Per Month

Per Job

Per Hour

How Often Paid?

Average Hours Per Pay Period

Commissions Tips Bonuses

Overtime Pay

 

 

FICA or FIT Withheld

Profit Sharing or Pension Plan

Yes

No

Frequently

Rarely

Never

Yes

No

Yes

No If yes, current value?

Health insurance available?

If yes, employee is:

 

 

 

Name of Insurance Company

Yes

No

Not Enrolled

Enrolled with Family Member

Enrolled for Self Only

 

 

 

 

 

 

 

 

Date Hired

 

Date First Check Received

Average Hours Per Week

If Employee

is or was on Leave Without Pay:

 

 

 

 

 

 

Start Date:

End Date:

 

 

 

 

 

 

 

 

 

Do you expect any changes to the above information within the next few months? Yes No

If yes, explain:

On the chart below, list all wages received by this employee during the month(s) of:

Date Pay

Period Ended

Date Employee

Received Paycheck

Actual Hours

Gross

Pay

Other Pay*

(tips, commissions, bonuses)

EITC

Advance

Total Pretax

Contributions

*Please explain (in comments section below) when and how often tips, commissions, or bonuses are received. Comments

If this person is no longer in your employ.

 

Date Separated

Reason for Separation

 

 

 

 

Date Final Check Received

 

 

Gross Amount of Final Check

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer – Read, Sign and Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I confirm that this information is true and correct to the best of my knowledge:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Signature

 

Date

Title

Area Code and Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

File Specs

Fact Name Fact Details
Purpose The Texas Employment Verification form is used to confirm the employment status of individuals applying for state benefits.
Governing Law This form is governed by Texas state law, specifically related to the administration of public assistance programs.
Required Information Employers must provide details such as the employee's job type, rate of pay, and employment dates.
Submission Methods Employers can return the completed form via mail, fax, or by giving it directly to the employee.
Employee Consent Employees must agree to allow their Social Security number to be shared with the employer for verification purposes.
Contact Information For assistance, individuals can contact Texas Health and Human Services at 2-1-1 or 877-541-7905.
Proof of Employment Employers are required to complete a “Proof of Employment” section to validate the employee's work status.
Health Insurance The form includes questions regarding the availability of health insurance for the employee.
Final Check Information If the employee is no longer employed, the employer must provide details about the final paycheck and the reason for separation.

Texas Employment Verification - Usage Guidelines

Filling out the Texas Employment Verification form is a straightforward process. This form requires specific information about the employee and their employment status. Once completed, the employer must return it to the appropriate agency. Follow these steps to ensure accurate completion.

  1. Start with the employee's Name and Address. Fill in the street address, city, state, and ZIP code as shown in your records.
  2. Provide the Date on which you are filling out the form.
  3. Indicate if the individual is or was employed by your company by checking Yes or No.
  4. If the answer is Yes, specify the type of job (Full Time, Part Time, Permanent, Temporary).
  5. Complete the Rate of Pay section by indicating how the employee is paid (Per Day, Per Week, Per Month, Per Job, Per Hour).
  6. Fill out the How Often Paid? section to indicate the payment frequency.
  7. Provide the Average Hours Per Pay Period worked by the employee.
  8. Include any additional compensation such as Commissions, Tips, Bonuses, and Overtime Pay.
  9. Indicate whether FICA or FIT is withheld from the employee's pay.
  10. Check if a Profit Sharing or Pension Plan is available to the employee.
  11. State whether Health insurance is available and provide the name of the insurance company if applicable.
  12. Record the Date Hired and the Date First Check Received.
  13. Fill in the Average Hours Per Week worked by the employee.
  14. If the employee is or was on Leave Without Pay, provide the Start Date and End Date.
  15. Answer if you expect any changes to the information within the next few months.
  16. Complete the wage chart for the months requested, including Date Pay Period Ended, Date Employee Received Paycheck, Actual Hours, Gross Pay, and Other Pay.
  17. In the comments section, explain how often tips, commissions, or bonuses are received.
  18. If the employee is no longer with your company, provide the Date Separated, Reason for Separation, and Date Final Check Received.
  19. Finally, sign and date the form, confirming that the information provided is true and correct to the best of your knowledge.

Once the form is completed, you can return it by giving it to the employee, mailing it in the pre-paid envelope, or faxing it to the designated number. Make sure to keep a copy for your records.

Your Questions, Answered

What is the Texas Employment Verification form?

The Texas Employment Verification form is a document used by employers to confirm the employment status and income of an employee or former employee. This information is often required when someone is applying for state benefits. The employer fills out the form and returns it to the Texas Health and Human Services Commission (HHSC).

Who needs to fill out the Employment Verification form?

The employer of the person applying for state benefits is responsible for completing the Employment Verification form. This includes providing details about the employee's job status, income, and any other requested information.

What information does the employer need to provide?

The employer must provide various details, including the employee's name, address, job status (full-time or part-time), rate of pay, and any benefits available, such as health insurance. Additionally, they should include information about the employee's earnings and any bonuses or commissions received.

How should the completed form be returned?

The employer can return the completed form in several ways. They can hand it back to the employee, mail it in the pre-paid envelope provided, or fax it to the designated number, which is 877-447-2839. It’s important to ensure that the form is returned promptly to avoid delays in the employee’s benefits application.

What if a question on the form does not apply?

If a question does not apply to the employee, the employer should mark it with "N/A" (not applicable). This helps clarify that the question was considered but does not pertain to the individual in question.

Is there a deadline for submitting the Employment Verification form?

What happens if the employee is no longer with the company?

If the employee is no longer employed, the employer should indicate the date of separation and the reason for it on the form. They must also provide the gross amount of the final paycheck received by the employee. This information is essential for the HHSC to assess the employee’s eligibility for benefits.

How can employers get assistance if they have questions about the form?

If employers have questions or need help while filling out the Employment Verification form, they can call 2-1-1 or 877-541-7905 for support. These resources are available to provide guidance and clarify any uncertainties regarding the form or the verification process.

Common mistakes

  1. Incomplete Information: Failing to fill out all required sections can lead to delays. Ensure every field is completed, especially the employer’s name and address.

  2. Incorrect Dates: Providing wrong dates for employment or separation can cause confusion. Double-check the dates before submission.

  3. Missing Signature: Both the employee and employer must sign the form. An unsigned form will not be processed.

  4. Failure to Indicate “N/A”: If a question does not apply, it is essential to mark it as “N/A.” Leaving it blank can be misinterpreted.

  5. Inaccurate Pay Information: Ensure that the rate of pay and frequency of payment are correct. Inaccuracies can affect eligibility for benefits.

  6. Neglecting to Include Contact Information: The employer’s contact details should be clearly listed. This helps in case follow-up is necessary.

  7. Ignoring Additional Comments: Use the comments section to clarify any unique circumstances. This can provide valuable context for the information provided.

  8. Not Following Submission Instructions: Be sure to return the form as specified, whether by fax, mail, or in person. Incorrect submission methods can lead to processing delays.

Documents used along the form

The Texas Employment Verification form is an essential document used to confirm an individual's employment status and income. However, it is often accompanied by several other forms and documents that provide additional context or necessary information for the verification process. Here are some of the most commonly used forms and documents that may be required alongside the Texas Employment Verification form.

  • Proof of Employment Form: This document, typically filled out by the employer, provides specific details about the employee's job status, including job title, type of employment, and pay rate.
  • W-2 Form: The W-2 form reports an employee's annual wages and the taxes withheld from their paycheck. It serves as an important record of income for verification purposes.
  • Pay Stubs: Recent pay stubs can provide evidence of an employee's current earnings and frequency of payment. They offer a snapshot of income that complements the employment verification.
  • Social Security Card: This card may be requested to confirm the employee's identity and Social Security number, ensuring accurate verification of their employment history.
  • Tax Returns: Personal tax returns can provide a broader view of an individual's income over the past year, which may be necessary for certain benefit applications.
  • Employment History Form: This form outlines the individual's previous employment, including dates of employment and job titles, which can help establish a complete work history.
  • Release of Information Form: This document allows the employer to share specific information about the employee with authorized parties, ensuring compliance with privacy regulations.

Each of these documents plays a vital role in verifying employment and income. Having them ready can streamline the process and help ensure that all necessary information is accurately conveyed. If you have questions about any of these forms, it’s advisable to reach out to the appropriate agency or your employer for guidance.

Similar forms

The Texas Employment Verification form shares similarities with the I-9 Employment Eligibility Verification form. Both documents serve the purpose of confirming an individual's employment status. The I-9 form is primarily used to verify a person's identity and eligibility to work in the United States. Like the Texas Employment Verification form, it requires the employer to provide specific details about the employee, including their name, address, and employment status. However, while the I-9 focuses on citizenship and immigration status, the Texas form is more concerned with employment details relevant to state benefits.

Another document that resembles the Texas Employment Verification form is the W-2 Wage and Tax Statement. Employers use the W-2 to report an employee's annual wages and the taxes withheld from their paycheck. Similar to the Texas form, the W-2 requires accurate information about the employee's earnings and employment duration. However, the W-2 is issued at the end of the tax year and serves a different purpose, primarily for tax reporting, while the Texas form is often used to determine eligibility for state benefits.

The Pay Stub also shares characteristics with the Texas Employment Verification form. A pay stub provides a breakdown of an employee's earnings for a specific pay period, including gross pay, deductions, and net pay. Like the Texas form, it offers insight into the employee's financial situation, which can be crucial when applying for benefits. However, pay stubs are typically generated on a regular basis, whereas the Texas Employment Verification form is a one-time request for information that may be used in the context of benefits eligibility.

Lastly, the Unemployment Insurance Benefits Claim form is another document that bears similarities to the Texas Employment Verification form. This form is used by individuals seeking unemployment benefits to provide information about their previous employment. Both forms require details about the employee's work history and earnings. However, the Unemployment Insurance form is focused on determining eligibility for unemployment compensation, while the Texas form is used to verify employment for state benefit applications.

Dos and Don'ts

When filling out the Texas Employment Verification form, it’s important to ensure accuracy and clarity. Here’s a list of four things you should and shouldn’t do:

  • Do double-check all information before submitting the form. Accuracy is crucial.
  • Do ensure that you provide all required signatures and dates. Missing these can delay the process.
  • Don’t leave any questions unanswered unless they do not apply. Mark those with "N/A" to avoid confusion.
  • Don’t forget to include your contact information. This helps if there are any questions about the form.

By following these guidelines, you can help ensure a smooth verification process. Remember, clarity and completeness are key!

Misconceptions

Understanding the Texas Employment Verification form is crucial for both employers and employees. Here are ten common misconceptions about this form:

  1. Only current employees need verification. Many believe that only current employees require verification. However, this form is also necessary for former employees who are applying for state benefits.
  2. The employer can refuse to fill out the form. Some think that employers can decline to complete the form. In reality, if the employee has signed the agreement, the employer is obligated to provide the requested information.
  3. Providing Social Security numbers is optional. Many assume that sharing a Social Security number (SSN) is optional. In fact, the employee must agree to allow the employer to provide this information for verification purposes.
  4. Employers can ignore questions they find irrelevant. It is a common belief that employers can skip questions they deem unnecessary. Instead, they should mark those questions as "N/A" to indicate they do not apply.
  5. All employers must submit the form to the state. Some individuals think that all employers are required to submit the form. Submission is only necessary if the employee is applying for state benefits.
  6. The form can be submitted in any format. There is a misconception that the form can be submitted in any way. Employers must follow the specified methods: mailing, faxing, or handing it back to the employee.
  7. Employers cannot charge for completing the form. Some believe that employers can charge employees for completing the form. However, this is not a standard practice and can be viewed negatively.
  8. Health insurance information is optional. Many think that providing health insurance details is not mandatory. However, this information is crucial for determining the employee’s benefits eligibility.
  9. The form does not need to be signed. A misconception exists that the form can be submitted without a signature. In reality, both the employer and employee must sign the form to validate the information provided.
  10. All information must be provided immediately. Some individuals believe that all information must be submitted instantly. Employers can indicate if they expect any changes in the future, which allows for updates later.

Key takeaways

Filling out and using the Texas Employment Verification form is a critical process for both employees and employers. Here are some key takeaways to consider:

  • Purpose of the Form: This form serves to verify employment for individuals applying for state benefits. It requires the employer to confirm the employment status and provide details about the employee's earnings.
  • Employer's Responsibility: Employers must fill out the form accurately and return it promptly. They can return the form by mailing it, faxing it, or giving it directly to the employee.
  • Employee Consent: Employees must agree to allow their employers to share their employment information. This consent is given by signing the form, which includes permission to disclose the employee's Social Security number.
  • Completing the Form: Employers should answer all questions thoroughly. If a question does not apply, they should mark it as "N/A." Providing accurate information is essential for the verification process.
  • Contact Information: If assistance is needed, employers and employees can reach out to the Texas Health and Human Services Commission or the Texas Workforce Commission using the provided phone numbers or email addresses.