Homepage Blank Texas Employment Verification Form
Outline

The Texas Employment Verification form serves a crucial role in the process of verifying an individual's employment status for state benefits. This form requires employers to provide essential information about their current or former employees, including the employee's name, Social Security number, and job details. Employers must confirm whether the individual is or was employed, specify the type of job, and indicate the rate of pay. The form also requests information about hours worked, any additional compensation like bonuses or commissions, and health insurance availability. It is vital that the employer fills out the “Proof of Employment” section accurately and returns the completed form by the specified deadline. Employees must consent to share their Social Security number for verification purposes, allowing the Texas Health and Human Services Commission (HHSC) to obtain necessary employment facts. For assistance, individuals can contact various support numbers provided on the form. Overall, this document streamlines the verification process, ensuring that applicants for state benefits receive the necessary support while maintaining compliance with employment verification requirements.

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.

 

 

 

 

 

 

 

 

 

 

 

 

Form Information

Fact Name Description
Purpose The Texas Employment Verification form is used by employers to confirm the employment status and income details of employees or former employees applying for state benefits.
Governing Law This form operates under the Texas Health and Human Services Commission guidelines, specifically related to the verification of employment for state benefit applications.
Submission Process Employers must fill out the form and return it by mail, fax, or hand delivery to the employee. A pre-paid envelope is provided for mailing.
Confidentiality Agreement Employees must agree to allow their Social Security number to be shared with the employer for the purpose of employment verification.

Detailed Guide for Filling Out Texas Employment Verification

Completing the Texas Employment Verification form is an important step in ensuring that the necessary employment information is accurately communicated. After filling out the form, it must be returned to the appropriate agency as specified. Below are the steps to guide you through the process of filling out this form.

  1. Begin by entering your Name and Address at the top of the form.
  2. Fill in the Date on which you are completing the form.
  3. Provide the Case Name and Case Number if applicable.
  4. Print your name in the section that states "I, (print your name)." This indicates your consent for the employer to share your information.
  5. Write your Social Security Number (SSN) in the designated area.
  6. Sign and date the agreement section to confirm your permission for the employer to provide your employment details.
  7. In the Employer section, the employer must fill out their Company or Employer Address.
  8. The employer should enter your name as it appears on their records in the Employee Name section.
  9. Provide your Employee Address as it appears on the employer's records.
  10. The employer needs to answer whether you are currently employed or were previously employed by them by selecting Yes or No.
  11. If the answer is Yes, the employer should indicate the type of job you held (Full Time, Part Time, etc.).
  12. Fill in the Rate of Pay in the appropriate sections (Per Day, Per Week, etc.).
  13. Indicate how often you are paid and the average hours worked per pay period.
  14. If applicable, provide details about commissions, tips, bonuses, and any deductions.
  15. The employer should also confirm if health insurance is available and provide the name of the insurance company if applicable.
  16. Complete the sections regarding the Date Hired, Date First Check Received, and Average Hours Per Week.
  17. If you were on Leave Without Pay, the employer must fill in the start and end dates.
  18. The employer needs to indicate if any changes to the information are expected in the coming months.
  19. List all wages received during the specified months in the provided chart, including gross pay and any other pay.
  20. If you are no longer employed, the employer should provide the Date Separated, Reason for Separation, and the Date Final Check Received.
  21. Finally, the employer must read, sign, and date the form to verify that the information is accurate.

After completing these steps, ensure that the form is returned either by giving it to the employee, mailing it in the pre-paid envelope, or faxing it to the specified number. This will ensure that the necessary information is processed without delay.

Obtain Answers on Texas Employment Verification

  1. What is the purpose of the Texas Employment Verification form?

    The Texas Employment Verification form is designed to confirm the employment status and income of individuals who are applying for state benefits. This form must be completed by the employer of the individual in question, providing essential details about their employment history and earnings.

  2. Who needs to fill out the form?

    Only the employer of the individual applying for state benefits is required to fill out this form. The employee or former employee must give consent for their employer to disclose their employment information.

  3. How should the employer submit the completed form?

    The employer has three options for returning the completed form:

    • Hand it directly to the employee listed on the form.
    • Mail it using the pre-paid envelope provided.
    • Fax it to 877-447-2839.
  4. What information is required from the employer?

    The employer must provide various details, including:

    • Employee's name and address
    • Employment status (full-time, part-time, etc.)
    • Rate of pay and how often the employee is paid
    • Average hours worked per pay period
    • Any additional compensation such as tips or bonuses
    • Health insurance availability
  5. What if a question on the form does not apply?

    If a particular question does not apply to the employee, the employer should simply mark it with "N/A." This helps ensure clarity and prevents confusion in the submission.

  6. What happens if the employee is no longer employed?

    If the individual is no longer with the company, the employer should still complete the form. They must provide the date of separation and the reason for it, along with the details of the final paycheck received by the employee.

  7. Is there a deadline for submitting the form?

    Yes, the form must be returned by a specified date, which is indicated on the form itself. Timely submission is crucial for the employee to receive the benefits they are applying for.

  8. Who can I contact for help with the form?

    If assistance is needed, individuals can call 2-1-1 or 877-541-7905. For those who are deaf, hard of hearing, or speech impaired, the number to call is 7-1-1 or 800-735-2989. All these numbers are free to call, ensuring that help is accessible to everyone.

Common mistakes

Filling out the Texas Employment Verification form accurately is crucial for both employees and employers. However, there are common mistakes that can lead to complications or delays in processing. Understanding these errors can help ensure a smoother experience.

One frequent mistake is failing to provide complete and accurate information in the employee’s name and address section. This information must match the records held by the employer. If discrepancies arise, it can create confusion and hinder the verification process. It is essential for the employer to double-check that the employee's details are correct before submitting the form.

Another common error involves not marking questions that do not apply with "N/A." When a question is left blank, it can lead to assumptions or misinterpretations. Employers should make it a point to fill out every section of the form, indicating where certain questions do not pertain to the employee's situation. This simple step can prevent unnecessary follow-up inquiries.

Additionally, some individuals overlook the importance of the signature and date at the bottom of the form. Without a signature, the form is incomplete and cannot be processed. Employers must ensure that they sign and date the form, confirming that the information provided is accurate to the best of their knowledge. This adds a layer of accountability and legitimacy to the document.

Another mistake is neglecting to provide detailed information regarding the employee's pay. Employers should accurately fill in the rate of pay, frequency of payment, and any additional earnings such as tips or bonuses. Incomplete financial information can lead to delays in processing state benefits for the employee, so thoroughness is key.

Lastly, failing to communicate any anticipated changes in employment status can create problems down the line. If an employer expects changes in the employee's information, such as a change in hours or pay, this should be clearly noted on the form. Transparency about potential changes helps the Texas Health and Human Services Commission manage expectations and provide accurate benefits.

Documents used along the form

The Texas Employment Verification form is an essential document for confirming an individual's employment status. Alongside this form, several other documents may be required to provide a complete picture of employment and benefits. Here’s a list of related forms and documents that are often used in conjunction with the Texas Employment Verification form.

  • Proof of Employment Form: This form is typically filled out by the employer to provide detailed information about the employee's job status, pay rate, and work hours. It is crucial for verifying employment for state benefits.
  • W-2 Form: Issued by employers, this form summarizes an employee's annual wages and the taxes withheld. It is often needed for tax purposes and can serve as proof of income.
  • Pay Stubs: These documents provide a breakdown of an employee's earnings for each pay period. They include details such as gross pay, deductions, and net pay, serving as proof of income and employment.
  • IRS Form 1099: For independent contractors or freelancers, this form reports income earned outside of traditional employment. It is essential for tax reporting and may be required for verification purposes.
  • Employment Offer Letter: This document outlines the terms of employment, including job title, salary, and start date. It can help verify employment status and conditions.
  • Termination Letter: If applicable, this letter provides official documentation of an employee's separation from the company. It may be necessary for confirming the end of employment for benefits assessments.
  • Social Security Administration (SSA) Earnings Statement: This statement provides a summary of an individual's earnings over their working life. It can be used to verify income and employment history when applying for benefits.

Each of these documents plays a significant role in verifying employment and income. They ensure that individuals receive the appropriate benefits and that employers comply with state regulations. Having these documents ready can streamline the verification process.

Similar forms

  • W-2 Form: This document provides information about an employee's annual wages and taxes withheld. Like the Texas Employment Verification form, it requires employer input and is used for verifying employment and income.
  • 1099 Form: Used for independent contractors, this form reports payments made to non-employees. It shares similarities with the Texas Employment Verification form in that it verifies income but is for different employment types.
  • Pay Stub: A pay stub shows an employee's earnings and deductions for a specific pay period. It is similar in that it provides proof of income and employment status.
  • Employment Verification Letter: This letter is issued by an employer to confirm an employee's job status and details. It serves a similar purpose as the Texas Employment Verification form but is typically more formal.
  • Form I-9: This form verifies an employee's identity and eligibility to work in the U.S. While its focus is on legal work status, it also relates to employment verification.
  • Unemployment Benefits Verification: This document confirms employment history for individuals applying for unemployment benefits. It parallels the Texas Employment Verification form in its aim to verify employment for benefits.
  • State Employment Verification Form: Different states may have their own forms to verify employment for state benefits. These forms often have similar requirements and purposes as the Texas form.
  • Social Security Administration Earnings Record: This record details an individual's earnings history. It is similar in that it provides proof of income and employment history.
  • Background Check Authorization Form: This form allows an employer to conduct a background check, which includes verifying employment history. It is related to the Texas Employment Verification form in its verification purpose.
  • Tax Return Transcript: This document summarizes an individual's tax return information. It can serve as proof of income and employment, similar to the Texas Employment Verification form.

Dos and Don'ts

When filling out the Texas Employment Verification form, it is essential to approach the task with care. Below are some key do's and don'ts to ensure the form is completed accurately and efficiently.

  • Do provide accurate information about the employee's job status and compensation.
  • Do fill out all applicable sections of the form completely.
  • Do indicate "N/A" for any questions that do not apply to the employee.
  • Do sign and date the form before returning it.
  • Do return the form using the pre-paid envelope or fax it to the designated number.
  • Don't leave any sections blank unless they are not applicable.
  • Don't provide false information, as this can lead to serious consequences.

Following these guidelines will help ensure that the employment verification process goes smoothly and that all necessary information is communicated effectively.

Misconceptions

Understanding the Texas Employment Verification form is essential for both employers and employees. However, there are several misconceptions that can lead to confusion. Here are ten common misconceptions explained:

  1. The form is optional for employers. Many believe that completing the form is not mandatory. In reality, employers are required to fill it out when requested to verify an employee's employment status.
  2. Only current employees need verification. Some think that the form is only for current employees. However, it can also be used for former employees who are applying for state benefits.
  3. Employees cannot refuse to provide their Social Security number. While the form requests a Social Security number, employees have the right to refuse if they do not consent. However, this may affect the verification process.
  4. Employers can provide any information they want. There is a misconception that employers can freely disclose any information. They must provide accurate and relevant information as specified in the form.
  5. The form is only for state benefits. Some individuals think the form is exclusively for state benefits. In fact, it can also be used for various tax credits and refunds related to employment.
  6. Returning the form is a simple process. Many believe that submitting the form is straightforward. However, employers must ensure they follow the instructions carefully to avoid delays.
  7. The form does not require a signature. There is a belief that a signature is not necessary. However, the employer must sign and date the form to confirm the information is accurate.
  8. All questions must be answered. Some think that every question on the form is mandatory. If a question does not apply, employers can simply mark it as "N/A."
  9. Health insurance information is optional. Many assume that health insurance details are not necessary. However, providing this information is crucial for accurate employment verification.
  10. The form is only relevant for certain industries. There is a misconception that the form applies only to specific sectors. In truth, it is relevant across various industries where employees may seek state benefits.

Being aware of these misconceptions can help streamline the employment verification process and ensure compliance with regulations. Clarity and accuracy are essential for both employers and employees involved in this procedure.

Key takeaways

Understanding the Texas Employment Verification form is crucial for both employees and employers. Here are some key takeaways to help you navigate the process effectively:

  • Purpose of the Form: This form is primarily used to verify the employment status of an individual who is applying for state benefits.
  • Employer Responsibility: Employers must complete and return the form accurately and promptly to assist the employee in their benefits application.
  • Employee Consent: Employees must agree to allow their employers to disclose their employment information, including their Social Security number.
  • Filling Out the Form: Employers should fill out the “Proof of Employment” section completely. If a question does not apply, they should indicate this with "N/A."
  • Return Options: Employers can return the completed form by giving it to the employee, mailing it in the provided envelope, or faxing it to the specified number.
  • Accurate Information: Employers must ensure all information, including rate of pay and employment status, is accurate and up-to-date.
  • Leave Without Pay: If the employee was on leave without pay, the employer should provide the start and end dates of that leave.
  • Future Changes: Employers should indicate if they expect any changes to the employee's information in the coming months.
  • Final Check Information: If the employee is no longer employed, the employer must provide the reason for separation and details about the final paycheck.
  • Signature Requirement: The form must be signed and dated by the employer, confirming that all provided information is true and correct.

By keeping these takeaways in mind, both employees and employers can ensure a smooth verification process that benefits everyone involved.