Homepage Blank Ccis Employment Verification Form
Outline

The Ccis Employment Verification Form serves a crucial role in the process of verifying an employee's work status and income, particularly for those seeking assistance with child care costs. This form requires detailed information from both the employee and their employer. Employers must provide their identification number, address, and contact details, along with specific information about the employee's job title, start date, and income. The form also captures the employee's work schedule, detailing hours worked each day and whether those hours fall in the A.M. or P.M. Additionally, it addresses the employee's status regarding pay frequency and whether they receive paystubs. For employees on extended leave or those with temporary or seasonal employment, the form includes sections to note these circumstances. Completing this form accurately is vital, as it directly impacts the employee's eligibility for subsidized child care programs. Employers are reminded to submit the completed form directly to the Early Learning Resource Center (ELRC), ensuring that an authorized representative, not the employee, fills it out. This verification process not only supports employees but also fosters a smoother experience for families seeking essential child care assistance.

Sample - Ccis 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
Employment Verication Form
CY 925 6/19
Employment Verication 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 specic and dened 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:
CY 925 6/19
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

Form Information

Fact Name Description
Purpose of the Form The Ccis Employment Verification Form is used to confirm an employee's job status and income for subsidized child care eligibility. It is essential for employees seeking assistance with child care costs.
Required Information Employers must provide specific details, including the employee's job title, income, work schedule, and whether the employee is newly hired. This information helps in assessing eligibility for financial assistance.
Completion Responsibility The form must be completed by an authorized company representative, not the employee. This ensures that the information provided is accurate and verified by someone in a position of authority.
Governing Law This form is governed by state laws related to child care assistance programs, which vary by state. For example, in Pennsylvania, it falls under the Child Care Development Block Grant regulations.

Detailed Guide for Filling Out Ccis Employment Verification

To complete the CCIS Employment Verification form, follow these steps carefully. This form is essential for verifying employment details for employees seeking assistance with child care costs. Accurate information will ensure that the verification process runs smoothly.

  1. Begin by filling in the Employer Name/Place of Employment at the top of the form.
  2. Next, enter the Immediate Supervisor’s Name and Immediate Supervisor’s Title.
  3. Authorize the release of information by signing your name in the Employee’s Printed Name section.
  4. Sign the form in the Employee’s Signature section and include the date.
  5. Complete the sections labeled for the employer:
    • Employer Identification Number (EIN)
    • Address of Employment
    • Employer’s Telephone Number
  6. Fill in the Employee Information section:
    • Employee’s Job Title
    • Indicate if the employee is newly hired by checking Yes or No.
    • Employment Start Date
  7. Provide details in the Employment Income section:
    • Hourly Rate
    • Gross Pay
    • Average Daily Tips
    • Next Pay Date
    • Select Pay Frequency (Weekly, Bi-Weekly, Twice a Month, Monthly).
    • Indicate how the employee receives pay (paystubs, cash, online access).
  8. Complete the Employment Schedule section:
    • Provide a 4-week sample schedule if the employee's hours vary.
    • For each week, fill in the dates and the specific hours worked for each day, indicating A.M. or P.M.
    • Calculate and write the total hours worked per week.
  9. If applicable, indicate if the employee is on Extended Leave and provide relevant dates.
  10. Complete the Temporary/Seasonal Employment section if relevant, including last dates of guaranteed employment or expected return dates.
  11. Finally, fill in the Employer’s Printed Name & Job Title, sign, and date the form.

Obtain Answers on Ccis Employment Verification

  1. What is the purpose of the CCIS Employment Verification Form?

    The CCIS Employment Verification Form is designed to verify an employee's employment status and income. This verification is crucial for determining eligibility for subsidized child care programs. The form must be completed by an authorized representative of the employer, not the employee themselves.

  2. Who is responsible for completing the form?

    An authorized company representative must fill out the form. This person should have access to accurate information regarding the employee’s job title, income, and work schedule. The employee cannot complete the form themselves, as it requires verification from the employer.

  3. What specific information is required from the employer?

    The employer must provide several key pieces of information, including:

    • Employer Identification Number (EIN)
    • Address of employment
    • Employer's telephone number
    • Employee's job title
    • Employment start date
    • Hourly rate and gross pay
    • Average daily tips
    • Pay frequency and next pay date
    • Detailed work schedule for a four-week period

  4. What if the employee’s work schedule varies?

    If the employee’s work schedule changes from week to week, the employer must provide a sample schedule for four weeks. This schedule should specify the days and hours worked, clearly indicating whether the hours are in the A.M. or P.M.

  5. How is the information used?

    The information provided on the form is used to assess the employee’s eligibility for subsidized child care. Accurate details regarding employment status and income are essential for this evaluation.

  6. Is the employee’s consent required for this verification?

    Yes, the employee must authorize the release of their employment information. This consent is typically indicated by the employee’s signature on the form, allowing the Early Learning Resource Center (ELRC) to verify the details provided.

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

    If the employee is on extended leave, the employer must indicate this on the form. The employer should provide the effective date of the leave and the expected return date. This information is important for understanding the employee's current employment status.

  8. How should the completed form be submitted?

    The completed form must be mailed directly to the Early Learning Resource Center (ELRC). It is important to ensure that the form is sent promptly to avoid delays in processing the employee’s eligibility for child care assistance.

  9. What if there are questions about completing the form?

    If there are any questions or uncertainties regarding how to fill out the form, employers can contact the ELRC directly. The contact information is provided on the form, ensuring that assistance is readily available.

Common mistakes

Filling out the CCIS Employment Verification form can seem straightforward, but there are common mistakes that can lead to delays or complications. Here are seven mistakes to watch out for when completing this important document.

First, many people forget to include the Employer Identification Number (EIN). This number is crucial for verifying the employer's identity. Without it, the form may be deemed incomplete. Make sure to double-check that this information is accurately provided.

Another frequent error is leaving the employee’s job title blank. This detail is essential for understanding the employee's role within the company. If this section is not filled out, it can cause unnecessary back-and-forth communication with the Early Learning Resource Center.

Additionally, some employers do not specify whether the employee is newly hired. This simple yes or no answer can significantly impact the verification process. Be sure to answer this question clearly to avoid confusion.

When it comes to the employment schedule, many people fail to indicate whether the hours are in A.M. or P.M. This oversight can lead to misunderstandings about the employee's working hours. Always clarify the time format to ensure accuracy.

Another common mistake is not providing a complete four-week sample schedule when the employee's hours vary. If the schedule changes from week to week, this information is vital for the verification process. Failing to include this can result in delays.

Some employers also overlook the section regarding extended leave. If an employee is on maternity or disability leave, this must be noted. Leaving this section blank can lead to complications in the verification of the employee’s eligibility for subsidized child care.

Finally, ensure that the form is signed by an authorized company representative. Many people mistakenly think that the employee can sign it. This is not the case. The form must be completed and signed by someone in a position of authority within the company.

By avoiding these common mistakes, you can help ensure that the CCIS Employment Verification form is completed accurately and efficiently, paving the way for a smoother verification process.

Documents used along the form

When navigating the employment verification process, especially in relation to child care subsidies, several key documents often accompany the CCIS Employment Verification Form. These documents provide additional context and information about the employee's work situation, ensuring that all necessary details are accurately captured. Below is a list of commonly used forms and documents that complement the employment verification process.

  • Pay Stubs: These documents serve as proof of income, detailing the employee's earnings over a specific period. Pay stubs typically include information such as gross pay, deductions, and net pay, providing a clear picture of the employee's financial situation.
  • W-2 Forms: Issued by employers at the end of the tax year, W-2 forms summarize an employee's annual earnings and the taxes withheld. This document is essential for verifying income and employment status over the previous year.
  • Employment Offer Letter: This letter outlines the terms of employment, including job title, salary, and start date. It serves as an official record of the employee's agreement with the employer, reinforcing the details provided in the employment verification form.
  • Job Description: A job description details the roles and responsibilities associated with a specific position. This document can help clarify the employee's job title and duties, which may be relevant for determining eligibility for certain programs.
  • Tax Returns: Personal tax returns can provide a comprehensive view of an employee's income over the past year. They are often used to verify income, especially for those who may have variable earnings.
  • Direct Deposit Authorization Form: This form indicates the employee's choice to receive their paycheck via direct deposit. It can provide additional confirmation of employment and payment practices.
  • Time Sheets: Time sheets record the hours worked by an employee over a specific period. They are particularly useful for verifying the accuracy of the employee's reported work schedule and hours.

Collectively, these documents play a crucial role in the employment verification process. They help ensure that all information is accurate and comprehensive, ultimately supporting the employee's eligibility for child care assistance. By understanding the purpose of each document, both employers and employees can navigate this process more effectively.

Similar forms

  • W-2 Form: This form provides details about an employee's annual wages and the taxes withheld. Like the Employment Verification form, it confirms employment status and income, essential for financial assistance programs.
  • Pay Stub: A pay stub shows an employee's earnings for a specific pay period. It contains information about hours worked and deductions, similar to the Employment Verification form's income section.
  • I-9 Form: The I-9 verifies an employee's eligibility to work in the U.S. It requires employer confirmation of employment, just like the Employment Verification form requires employer input.
  • Employment Offer Letter: This document outlines the terms of employment, including job title and salary. It serves a similar purpose in confirming employment details as the Employment Verification form.
  • Reference Letter: A reference letter from an employer can confirm employment history and job performance. It aligns with the Employment Verification form's purpose of validating employment.
  • Job Description: This document details an employee's responsibilities and role within a company. It is similar in that it provides context about the employee's position, much like the job title section of the Employment Verification form.
  • Performance Review: A performance review assesses an employee's work and contributions. It can validate employment and role, akin to the Employment Verification form's verification process.
  • Separation Notice: This document is issued when an employee leaves a job. It confirms employment dates and reasons for separation, similar to the Employment Verification form's focus on employment history.
  • State Employment Verification Form: Many states have their own forms for verifying employment. These documents serve the same purpose as the Employment Verification form, confirming employment status for various benefits.

Dos and Don'ts

When filling out the CCIS Employment Verification form, it’s essential to ensure accuracy and clarity. Here are some dos and don’ts to keep in mind:

  • Do provide complete and accurate information for each section of the form.
  • Do ensure that the employer’s printed name and signature are included at the end of the form.
  • Do specify whether the employee is newly hired and provide the employment start date.
  • Do clearly indicate the employee's work schedule, including specific A.M. or P.M. times.
  • Don't leave any sections blank; all required fields must be filled out.
  • Don't provide vague information about the employee's hours or income; be as specific as possible.
  • Don't submit the form without verifying that all details are accurate and up to date.

Misconceptions

Understanding the Ccis Employment Verification form is essential for both employers and employees. However, several misconceptions can lead to confusion. Here are six common misconceptions:

  • The form can be completed by the employee. In reality, an authorized company representative must fill out the form, ensuring that the information provided is accurate and verified.
  • All sections of the form are optional. This is not true. Certain sections, such as the employment schedule and income details, must be completed to determine eligibility for subsidized child care.
  • The form is only for full-time employees. This misconception is misleading. The form can be used for both full-time and part-time employees, as long as the necessary information is provided.
  • Employers can submit the form directly to the employee. This is incorrect. The completed form must be mailed directly to the Early Learning Resource Center (ELRC), not given to the employee.
  • There is no need for a detailed work schedule. In fact, a specific work schedule is crucial. Employers must indicate the exact days and hours the employee works, including whether those hours are in the A.M. or P.M.
  • Employers can ignore the income verification section. This is a misunderstanding. Accurate income information is vital for assessing the employee's eligibility for the subsidized child care program.

Addressing these misconceptions can help streamline the process and ensure that employees receive the assistance they need for child care costs.

Key takeaways

Filling out the CCIS Employment Verification form is an important step in assisting employees with their child care costs. Here are key takeaways to keep in mind:

  • Accurate Information is Crucial: Ensure that all sections of the form are filled out completely and accurately. This includes details such as the employer's identification number, employee's job title, and employment income.
  • Schedule Clarity: Clearly indicate the employee's work schedule, specifying hours in either A.M. or P.M. If the schedule varies, provide a 4-week sample to avoid confusion.
  • Authorized Signature Required: The form must be completed and signed by an authorized company representative, not the employee themselves. This helps maintain the integrity of the verification process.
  • Timely Submission: Mail the completed form directly to the Early Learning Resource Center (ELRC) as soon as possible. Delays in submission can affect the employee's eligibility for assistance.
  • Extended Leave Information: If the employee is on extended leave, indicate the type of leave and relevant dates. This information is essential for accurately assessing eligibility for subsidized child care.
  • Contact ELRC for Assistance: If there are any questions or uncertainties while completing the form, do not hesitate to reach out to the ELRC for guidance. They are available to assist and ensure the process goes smoothly.

By following these guidelines, you can help facilitate the process for employees seeking child care assistance. Your attention to detail and commitment to accuracy make a significant difference.