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The CCIS Employment Verification Form plays a crucial role in determining an employee's eligibility for subsidized child care assistance. This form requires specific information from both the employer and the employee, ensuring a thorough verification process. Employers must provide essential details such as their name, address, and contact information, along with the employee's job title and employment start date. Additionally, the form captures vital financial data, including the employee's hourly rate, gross pay, and pay frequency. A comprehensive work schedule, detailing the days and hours worked, is also necessary. This information is vital as it helps the Early Learning Resource Center (ELRC) assess the employee's situation accurately. Employers need to complete this form accurately and submit it directly to the ELRC, emphasizing the importance of clear and precise documentation. By understanding the requirements and purpose of this form, employers can assist their employees in accessing essential child care support.

Ccis Employment Verification Example

 

 

 

 

 

Employment Verification Form

 

 

 

EMPLOYER NAME/PLACE OF EMPLOYMENT:

IMMEDIATE SUPERVISOR’S NAME:

IMMEDIATE SUPERVISOR’S TITLE:

 

 

 

 

 

 

 

 

 

I authorize the release of this information and give permission to the Early Learning Resource Center (ELRC) to verify all information contained in this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYEE’S PRINTED NAME

 

 

EMPLOYEE’S SIGNATURE

 

 

DATE

 

THE FOLLOWING SECTIONS MUST BE COMPLETED BY THEIR EMPLOYER

EMPLOYER IDENTIFICATION NUMBER (EIN):

ADDRESS OF EMPLOYMENT:

EMPLOYER’S TELEPHONE NUMBER:

(______) ______ - ____________

EMPLOYEE INFORMATION

EMPLOYEE’S JOB TITLE:

Is the above-mentioned employee newly hired?

Yes

No

EMPLOYMENT START DATE:

______ / ______ / ____________

EMPLOYMENT INCOME

HOURLY RATE:

GROSS PAY:

AVERAGE DAILY TIPS:

NEXT PAY DATE:

PAY FREQUENCY:

 

 

 

$

$

$

___ / ___ / ______

Weekly

Bi-Weekly (26 pays/year)

Twice a Month (24 pays/year)

Monthly

The employee: receives paystubs does NOT receive paystubs receives pay in CASH has access to pay online via the following website:

EMPLOYMENT SCHEDULE (Please indicate the days and hours the employee works and indicate whether the hours occur during A.M. or P.M.)

NOTE: If the schedule varies, please give a 4-week sample schedule.

WEEK ONE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK TWO

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK THREE

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

WEEK FOUR

Dates: from:__________________

 

 

to:____________________

Mon.

from_________ a.m./p.m. to_________

a.m./p.m.

Tues.

from_________ a.m./p.m. to_________

a.m./p.m.

Wed.

from_________ a.m./p.m. to_________

a.m./p.m.

Thur.

from_________ a.m./p.m. to_________

a.m./p.m.

Fri.

from_________ a.m./p.m. to_________

a.m./p.m.

Sat.

from_________ a.m./p.m. to_________

a.m./p.m.

Sun.

from_________ a.m./p.m. to_________

a.m./p.m.

TOTAL # HOURS/WEEK: _________________________

Effective begin date of schedule change:

EXTENDED LEAVE

Is the employee on extended leave (maternity, disability, etc.)?

Yes

No

Effective begin date of extended leave: ___ / ___ / ______

Date returned from extended leave: ___ / ___ / ______

TEMPORARY/SEASONAL EMPLOYMENT

Is the employee considered to be a temporary hire?

Yes

No

If the employee is considered a temporary hire, what is the last date of guaranteed employment? ___ / ___ / ______

If the employee is seasonal, please give: Last day of work before break: ___ / ___ / ______

 

Expected date of return following break: ___ / ___ / ______

 

 

 

 

 

 

I understand that the information I am providing will be used to determine the above-named employee’s eligibility for

subsidized child care.

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER’S PRINTED NAME & JOB TITLE

 

 

EMPLOYER’S SIGNATURE

 

 

DATE

 

CY 925 6/19

Employment Verification Form

Dear Employer:

One of your employees has requested assistance paying his/her child care costs. We must verify his/her employment with you. This information will help us determine if this employee is eligible for the subsidized child care program. The form must be mailed directly to the Early Learning Resource Center (ELRC).

An authorized COMPANY REPRESENTATIVE (not the employee) must complete this form.

We must have an accurate record of your employee’s work schedule and employment income. Please complete the information on the back of this page. It is very important that the hours shown are specific and defined as either A.M. or P.M. (For example, 7:30 a.m. - 3:30 p.m.). If the employee’s schedule varies, please give a 4-week sample schedule. You do not need to give a 4-week sample schedule unless the employee’s schedule varies from week to week.

Thank you for your time and assistance. If you have any questions about how to complete this form, please contact the ELRC listed below.

ELRC:

Early Learning Resource Center Region 17

PO Box 311

1430 DeKalb Street

Norristown, PA 19404-0311

(610)278-3707 or (800) 281-1116 Fax (610) 278-5161

CY 925 6/19

File Breakdown

Fact Name Details
Purpose The form verifies employment for employees seeking subsidized child care assistance.
Employer Requirement An authorized company representative, not the employee, must complete the form.
Employee Information Includes employee's name, job title, and employment start date.
Income Details Employers must provide hourly rate, gross pay, and average daily tips.
Schedule Submission A 4-week sample schedule is required if the employee's hours vary.
Extended Leave Employers must indicate if the employee is on extended leave and provide relevant dates.
Temporary Employment Employers must state if the employee is temporary or seasonal and provide end dates.
Submission Method The completed form must be mailed directly to the Early Learning Resource Center (ELRC).
Governing Law The form is governed by Pennsylvania state law regarding child care subsidies.

Guide to Using Ccis Employment Verification

Completing the Ccis Employment Verification form is essential for verifying an employee's eligibility for subsidized child care. Follow these steps to ensure the form is filled out correctly and completely.

  1. Start by entering the Employer Name/Place of Employment at the top of the form.
  2. Fill in the Immediate Supervisor’s Name and Immediate Supervisor’s Title.
  3. Provide the Employee’s Printed Name and have the employee sign the form, including the Date.
  4. Complete the sections that must be filled out by the employer:
    • Employer Identification Number (EIN)
    • Address of Employment
    • Employer’s Telephone Number
  5. Fill out the Employee Information section:
    • Employee’s Job Title
    • Indicate if the employee is newly hired by checking Yes or No.
    • Employment Start Date
  6. Provide the Employment Income details:
    • Hourly Rate
    • Gross Pay
    • Average Daily Tips
    • Next Pay Date
    • Select the Pay Frequency (Weekly, Bi-Weekly, Twice a Month, Monthly).
  7. Indicate how the employee receives pay:
    • Check the appropriate box for paystubs, cash, or online access.
  8. Complete the Employment Schedule section:
    • Provide a 4-week sample schedule if the hours vary.
    • Fill in the days and hours the employee works, specifying A.M. or P.M.
  9. If applicable, indicate if the employee is on Extended Leave and provide the relevant dates.
  10. Specify if the employee is Temporary/Seasonal and provide the last date of guaranteed employment or expected return date.
  11. Finally, the employer must print their name and job title, sign, and date the form.

After completing the form, ensure it is mailed directly to the Early Learning Resource Center (ELRC). This step is crucial for the employee's eligibility assessment. If there are any questions, reach out to the ELRC for assistance.

Get Answers on Ccis Employment Verification

What is the purpose of the CCIS Employment Verification form?

The CCIS Employment Verification form is designed to verify an employee's employment status and income. This information is essential for determining eligibility for subsidized child care assistance. Employers complete this form to provide accurate details about the employee's job title, income, and work schedule.

Who needs to fill out the form?

The form must be completed by an authorized company representative, not the employee themselves. This ensures that the information provided is accurate and reliable. The representative should be someone familiar with the employee's work situation, such as a supervisor or HR personnel.

What information is required from the employer?

Employers need to provide several key details, including:

  • Employer name and address
  • Employer Identification Number (EIN)
  • Employee's job title
  • Employment start date
  • Income details such as hourly rate and gross pay
  • Work schedule, including specific days and hours

Accurate and complete information is crucial for the verification process.

How should the work schedule be reported?

The work schedule should be detailed, indicating the days and hours the employee works. Each entry must specify whether the hours are in the A.M. or P.M. If the employee's schedule varies week to week, a four-week sample schedule must be provided.

What if the employee is on leave?

If the employee is on extended leave, such as maternity or disability leave, this must be indicated on the form. Employers should provide the effective start date of the leave and the date the employee is expected to return. This information helps in assessing the employee's current work status.

Can the form be submitted electronically?

The form must be mailed directly to the Early Learning Resource Center (ELRC). Electronic submissions are not accepted. This ensures that the information is processed correctly and securely.

What happens if the information is incorrect?

Providing inaccurate information can lead to delays or denial of the employee's eligibility for subsidized child care. Employers should double-check all details before submitting the form to ensure accuracy and completeness.

Where can employers get help with the form?

If employers have questions about completing the form, they can contact the ELRC. The contact information is provided on the form, including phone numbers and a mailing address. Assistance is available to ensure that the form is filled out correctly.

Common mistakes

Completing the CCIS Employment Verification form can be a straightforward process, but many people encounter common pitfalls that can lead to delays or complications. Here are eight mistakes to watch out for when filling out this important document.

First, one of the most frequent errors is failing to provide the correct employer identification number (EIN). This number is essential for identifying the business and ensuring that the employee's information is accurately linked to the correct employer. Double-checking this number can save time and avoid confusion.

Another mistake often made is neglecting to specify the employee's job title. This detail is crucial, as it helps the Early Learning Resource Center (ELRC) understand the employee's role and responsibilities. Omitting this information can lead to misunderstandings about the nature of the employment.

Additionally, some individuals forget to indicate whether the employee is newly hired. This question is straightforward but important. It helps the ELRC determine the employee's eligibility for assistance based on their employment status.

Providing an incomplete or inaccurate employment schedule is also a common error. It is vital to specify the days and hours the employee works, clearly indicating whether these hours fall in the A.M. or P.M. If the schedule varies, a four-week sample is required. Without this information, the ELRC cannot accurately assess the employee's situation.

Moreover, failing to indicate the pay frequency can lead to confusion. The form provides options such as weekly, bi-weekly, or monthly. Selecting the correct frequency ensures that the ELRC understands how often the employee receives their paycheck, which can affect their eligibility for financial assistance.

Another oversight is not providing the average daily tips if applicable. If the employee earns tips as part of their income, this information should be included. It contributes to a complete picture of the employee's earnings and can impact their eligibility for subsidized child care.

Some people also forget to sign and date the form. This step may seem minor, but without a signature, the form is incomplete and cannot be processed. Ensuring that all required signatures are present is essential for the form's acceptance.

Lastly, not mailing the form directly to the ELRC can cause significant delays. The instructions clearly state that the form must be sent directly from the employer. Following this directive helps expedite the verification process and ensures that the employee receives the assistance they need in a timely manner.

By being aware of these common mistakes and taking the time to review the form carefully, employers can help facilitate a smoother verification process. Attention to detail is key in ensuring that employees receive the support they need for their child care costs.

Documents used along the form

When completing the CCIS Employment Verification form, several other documents may be needed to provide additional context and support for the employment verification process. These documents help ensure that all necessary information is accurately captured and verified, aiding in the assessment of an employee's eligibility for subsidized child care. Below are some commonly used forms and documents that accompany the CCIS Employment Verification form.

  • Pay Stubs: These are documents issued by an employer that detail an employee's earnings for a specific pay period. Pay stubs typically include information such as gross pay, deductions, and net pay, which can help confirm the employee's income as reported on the verification form.
  • W-2 Forms: A W-2 form is an annual tax document provided by employers to their employees. It summarizes the employee's total earnings and tax withholdings for the year. This form serves as a reliable source for verifying an employee's income and employment status.
  • Employment Offer Letter: This letter is issued to a new employee at the time of hiring. It outlines the terms of employment, including job title, salary, and start date. An offer letter can provide essential context regarding the employee's role and compensation.
  • Identification Documents: These may include a driver's license or other forms of ID that verify the employee's identity. Such documents can be essential for ensuring that the information provided on the employment verification form matches the individual seeking assistance.

Incorporating these documents along with the CCIS Employment Verification form can streamline the verification process and help ensure that all necessary information is available for review. This thorough approach not only aids in the determination of eligibility for subsidized child care but also fosters transparency and accuracy in employment verification.

Similar forms

  • W-2 Form: Similar to the Ccis Employment Verification form, the W-2 form provides essential information about an employee’s earnings and tax withholdings for the year. Both documents require employer verification and detail employment income, making them crucial for financial assessments.
  • Pay Stub: A pay stub, like the Ccis form, outlines an employee's earnings for a specific pay period. It includes details such as hourly rates, gross pay, and deductions, which help verify the employee's income and work hours.
  • Employment Letter: An employment letter serves as a formal confirmation of an individual's job status, similar to the Ccis form. It typically includes job title, employment dates, and salary information, helping to validate employment for various purposes.
  • Verification of Employment (VOE) Form: This document is used by lenders and other entities to confirm an individual's employment status. Like the Ccis form, it requires employer input and often includes similar information about job title, income, and employment duration.
  • Form I-9: The I-9 form is used to verify an employee's eligibility to work in the United States. While it focuses on identity and employment authorization, both forms require detailed employer information and signatures to confirm the validity of the data provided.
  • Job Offer Letter: A job offer letter outlines the terms of employment, including job title, salary, and start date. It shares similarities with the Ccis form in that it serves as an official document confirming employment, although it is typically issued before employment begins.

Dos and Don'ts

When filling out the CCIS Employment Verification form, it is essential to follow certain guidelines to ensure accuracy and compliance. Here are some important dos and don'ts:

  • Do provide accurate and complete information about the employee's job title and employment status.
  • Do include the employer identification number (EIN) and the correct address of employment.
  • Do specify the employee's pay frequency and provide detailed income information, including hourly rate and gross pay.
  • Do clearly indicate the employee's work schedule, including specific days and hours in A.M. or P.M.
  • Don't leave any sections blank; all required fields must be filled out to avoid delays.
  • Don't provide vague descriptions of the employee's schedule; be precise with times.
  • Don't submit the form without an authorized company representative's signature.
  • Don't forget to mail the completed form directly to the Early Learning Resource Center (ELRC) as instructed.

By adhering to these guidelines, you can help ensure that the employment verification process runs smoothly and efficiently.

Misconceptions

Misconceptions about the Ccis Employment Verification form can lead to confusion for both employers and employees. Here are six common misconceptions explained:

  • The form is optional for employers. Some believe that completing the form is optional. However, it is a requirement for employers to provide this information to verify an employee's eligibility for subsidized child care.
  • Any employee can fill out the form. Many think that employees can complete the form themselves. In reality, it must be filled out by an authorized company representative, not the employee.
  • Income information is not necessary. Some assume that providing income details is unnecessary. This is not true, as accurate income information is crucial for determining eligibility for child care assistance.
  • Work schedules do not need to be detailed. There is a misconception that a general work schedule is sufficient. In fact, employers must provide specific days and hours worked, clearly indicating A.M. or P.M. times.
  • The form can be submitted by the employee. It is often thought that employees can mail the form themselves. However, the form must be sent directly from the employer to the Early Learning Resource Center (ELRC).
  • Temporary or seasonal employment is not relevant. Some believe that the employment status of being temporary or seasonal does not need to be reported. This is incorrect, as this information is essential for understanding the employee's work situation.

Understanding these misconceptions can help streamline the verification process and ensure that employees receive the assistance they need.

Key takeaways

Here are some key takeaways about filling out and using the CCIS Employment Verification form:

  • Complete all required sections: Ensure that both the employer and employee sections are filled out completely.
  • Employer's role: An authorized company representative must complete the form, not the employee.
  • Accurate information: Provide correct details about the employee's job title, income, and work schedule.
  • Specific hours: Clearly indicate whether the employee's work hours are in A.M. or P.M. for clarity.
  • Sample schedule: If the employee's schedule varies, include a 4-week sample to give a clear picture of their hours.
  • Mail directly: The completed form must be sent directly to the Early Learning Resource Center (ELRC).
  • Confidentiality: The employee must authorize the release of their information for verification purposes.
  • Contact ELRC: If there are questions about completing the form, reach out to the ELRC for assistance.