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Get and Sign H1028 Proof Employment 2015-2022 Form
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.
___________________________________
Sign here
_______________________
Date
Employer -- your help is needed:
We need proof that the following person is or was your employee.
Employee...
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