Employment Verification Certificate

EMPLOYMENT VERIFICATION CERTIFICATE

Requesting Party / Recipient

Employer (Verifying Entity)

Subject Employee Information

Employee Name:

Employee ID/Badge (if applicable):

Employment Details Being Verified

Job Title:    Department:

Employment Status: Active Terminated On Leave

Date of Hire:    Date of Separation (if applicable):

Current or Final Base Compensation:    Pay Frequency:

Verification Statement and Certification

The undersigned verifier, authorized by the employer named above, certifies that the information contained in this certificate is true, accurate, and complete to the best of the verifier's knowledge. This verification is provided for the specific purpose stated by the recipient and may not be relied upon for other purposes without the employer's prior written consent.

The employer's records indicate the employment details set forth above. This document does not constitute a contract of employment and does not alter the at-will nature of employment unless expressly stated in a separate signed agreement.

Employee Authorization to Release Information

I, the employee named above, authorize the employer to disclose the employment information requested to the recipient identified in this form. I understand that this authorization permits disclosure of dates of employment, position title, compensation, employment status, and the duties described above. I further understand that such disclosures will be limited to factual information and do not include medical or other confidential personnel file contents unless separately authorized in writing.

Employee Signature (electronic or handwritten) indicates consent to release the specified employment information to the recipient for the stated purpose.

Applicant / Employee Supplemental Information

Education

Professional References (Provide three)

Legal Disclosures

At-Will Employment: Nothing in this employment verification certificate creates an employment contract or guarantees continued employment. Unless an explicit written agreement signed by an authorized representative of the employer states otherwise, employment may be terminated at will by either party.

Equal Employment Opportunity: The employer provides equal employment opportunities without regard to protected characteristics as required by applicable law. The disclosure of employment information through this certificate will be made in a manner consistent with applicable privacy and employment laws.

Applicant / Employee Certification and Authorization

I certify that all information provided on this form is true and correct. I authorize the employer to release the employment information requested to the recipient named above. I understand that knowingly making a false statement on this document may subject me to disciplinary action, up to and including termination, and may have legal consequences.

I further authorize the recipient to retain a copy of this verification for their records and to use the information for the stated verification purpose only.

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