Employment VOE Request Form

EMPLOYMENT VOE REQUEST FORM

Requestor Information

Requesting Organization:

Subject (Employee) Information

Employee Full Legal Name:

Date of Birth:    Last 4 of SSN:

Position Information

Reporting Manager:    Hire Date:    Termination Date (if applicable):

Employment Status: Full-time    Part-time    Temporary/Contract

Pay Frequency:

Employment History (Most Recent Two Employers)

Title:    Dates Employed:

Title:    Dates Employed:

Education

Graduation Date:

References (Professional)

Phone:    Email:

Phone:    Email:

Phone:    Email:

Verification Requested (Check all that apply)

Dates of employment    Job title    Salary / hourly rate

Full-time / part-time status    Reason for separation / termination    Rehire eligibility

Authorization and Consent (Employee)

I, the undersigned employee, hereby authorize my current or former employer to disclose the requested employment information to the requesting organization for the limited purpose stated herein. This authorization is voluntary and limited to information necessary to verify dates of employment, job title, compensation, and separation status unless otherwise specified above. I understand that the information disclosed will be used only for legitimate business purposes, including but not limited to credit underwriting, tenancy screening, or employment screening.

I release the employer and its representatives from liability for providing the requested factual information. I understand that this authorization will remain in effect for 30 days from the date of my signature unless I revoke it in writing sooner. I may revoke this authorization by submitting written notice to Human Resources; however, any action taken by the requester prior to receipt of the revocation will not be affected.

By checking the box below and signing, I certify that the information I have provided on this form is true and correct to the best of my knowledge and that I authorize both release of the requested employment verification information and the requesting organization to use such information for the stated purpose.

I authorize release of the requested employment information and certify accuracy of the information provided above.

Legal Disclosures

At-Will Employment: Nothing in this form alters the at-will employment relationship between the employer and employee where applicable. Either the employer or the employee may terminate the employment relationship at any time, with or without cause or notice, unless a separate written agreement provides otherwise.

Equal Opportunity: The employer complies with all applicable equal employment opportunity laws. Employment verification responses provided pursuant to this request will be limited to factual job-related information and will not be used to discriminate against the employee on any protected basis.

Authorization To Contact Prior Employers / Background Checks

I further authorize the requesting organization to contact prior employers listed above for purposes of employment verification and to obtain consumer or other background reports where necessary for the permissible purpose stated. I understand that additional consents may be requested by the requesting organization if a consumer report will be obtained.

I consent to contact with prior employers and background checks as described.

Human Resources - Verification Response (For Employer Use Only)

Verified Dates of Employment:    Verified Title:

Verified Compensation:    Pay Frequency:

Rehire Eligibility: Eligible    Ineligible    Unknown

HR Verified By (Name and Title):

Date Verified:

Certification

I certify that all information provided on this form is true and complete. I understand that knowingly providing false information may subject me to disciplinary action and may void this authorization. By signing below, I authorize release of the requested employment information to the requesting organization and acknowledge receipt of a copy of this authorization upon request.

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