Employee Attendance Verification

EMPLOYEE ATTENDANCE VERIFICATION

Personal Information

Position & Employment Information

Active On leave Terminated Other:

Period of Attendance Verification

Verification Period Start:    End:

Attendance Summary

Total Scheduled Work Days in Period:
Days Present:
Days Absent (unplanned):
Authorized Leave (sick):
Authorized Leave (vacation):
Instances of Late Arrival (tardies):
Total Minutes Late (aggregate):

Payroll records Timeclock/Badge system Manual timecards/logs Other:

Employment History (for verification context)

Employer 1 — Company Name

Dates Employed (from/to): to

Employer 2 — Company Name

Dates Employed (from/to): to

Education

Graduation / Completion Date:

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures & Certifications

At-Will Employment Statement: The information provided in this verification reflects attendance data only and does not alter the at-will employment relationship between the employer and the employee, if applicable. Nothing in this form should be construed as a contract of employment for any specified duration.

Equal Opportunity Statement: The employer certifies that records used to prepare this verification are maintained in compliance with applicable non-discrimination obligations and company policy.

Applicant / Employee Certification: I certify that the information provided by me on this form (if any) is true and complete to the best of my knowledge and that I authorize the employer to release the attendance information set forth above for the stated verification purpose.

Authorization: By signing below, the authorized employer representative attests that the attendance records reviewed are maintained in the normal course of business, are accurate to the best of their knowledge, and that release of this information is permitted. This verification is furnished solely for the purpose stated by the requestor and further redistribution or use for unrelated purposes is prohibited without written consent of the employer or as required by law.

Certification by Employer Representative

I hereby certify under penalty of perjury that the attendance information recorded on this form accurately reflects the employer's official attendance records for the period indicated above. I understand that knowingly providing false information on an employment verification may subject me or the organization to administrative or legal penalties.

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