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The Texas Employment Verification form plays a crucial role in the process of confirming an individual's employment status, particularly for those applying for state benefits. This form is primarily designed for employers to provide necessary information about their current or former employees. Essential details required include the employee's name, Social Security number, and employment history, such as job type and rate of pay. Employers must also indicate whether the employee is full-time or part-time, along with their average hours worked per week and any additional compensation like bonuses or commissions. This verification process is vital, as it helps the Texas Health and Human Services Commission (HHSC) assess eligibility for various state programs. Employers are instructed to fill out the form accurately and return it through one of several methods, including fax or mail. Moreover, the form includes a section where employees must consent to the sharing of their information, ensuring transparency and compliance with privacy regulations. Understanding the importance of this form can help both employers and employees navigate the employment verification process smoothly.

Texas Employment Verification Example

Name and Address

Date

Need help? Call 2-1-1 or 877-541-7905.

Fax: 877-447-2839

Mail:

Texas Health and Human Services Commission

P O BOX 149027

Austin, Texas 78714-9027

If you are deaf, hard of hearing, or speech impaired, call 7-1-1 or 800-735-2989. All numbers are free to call.

Case Name

Case No.

This form is for your employer. They need to fill out the form and return it by. You must agree to let them give facts about you.

Fill Out and Sign This 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.

Signature

Date

Employer – Your Help Is Needed

Employee or Former Employee

Social Security No.

We need proof that the following person is or was your employee.

Some employers might get tax refunds or tax credits for hiring people who get certain state benefits.

To learn more, go to TexasWorkforce.org/wotc or email the Texas Workforce Commission at [email protected].

Employer please follow these steps.

This person lives in a home in which someone is applying for state benefits. We need to know the amount of money this person makes or made from this job.

1.Please fill out the “Proof of Employment” form on the next page.

2.If a question doesn't apply, mark it with "N/A."

3.Return the form:

To send this back to us, you can either:

(a)give it to the employee listed above,

(b)mail it in the pre-paid envelope, or (c) fax it to 877-447-2839.

Form H1028 / 07-2022

Employment Verification

Form H1028

Page 2 / 07-2022-E

Proof of employment to be filled out by the employer.

Company or Employer

Address (Street, City, State, ZIP code)

Employee Name (as shown on your records)

Employee Address (Street, City, State, ZIP Code – as shown on your records)

Is (or was) this person employed by you?

If yes, what type of job?

 

 

Yes

No

Full Time

Part Time

Permanent

Temporary

If no: Stop here – sign and date the bottom of this form and return it.

If yes: Answer all the questions below. If a question doesn’t apply, write “N/A".

Rate of Pay

Per Day

Per Week

Per Month

Per Job

Per Hour

How Often Paid?

Average Hours Per Pay Period

Commissions Tips Bonuses

Overtime Pay

 

 

FICA or FIT Withheld

Profit Sharing or Pension Plan

Yes

No

Frequently

Rarely

Never

Yes

No

Yes

No If yes, current value?

Health insurance available?

If yes, employee is:

 

 

 

Name of Insurance Company

Yes

No

Not Enrolled

Enrolled with Family Member

Enrolled for Self Only

 

 

 

 

 

 

 

 

Date Hired

 

Date First Check Received

Average Hours Per Week

If Employee

is or was on Leave Without Pay:

 

 

 

 

 

 

Start Date:

End Date:

 

 

 

 

 

 

 

 

 

Do you expect any changes to the above information within the next few months? Yes No

If yes, explain:

On the chart below, list all wages received by this employee during the month(s) of:

Date Pay

Period Ended

Date Employee

Received Paycheck

Actual Hours

Gross

Pay

Other Pay*

(tips, commissions, bonuses)

EITC

Advance

Total Pretax

Contributions

*Please explain (in comments section below) when and how often tips, commissions, or bonuses are received. Comments

If this person is no longer in your employ.

 

Date Separated

Reason for Separation

 

 

 

 

Date Final Check Received

 

 

Gross Amount of Final Check

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer – Read, Sign and Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I confirm that this information is true and correct to the best of my knowledge:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Signature

 

Date

Title

Area Code and Phone No.

 

 

 

 

 

 

 

 

 

 

 

 
Click for Texas Employment Verification File

File Breakdown

Fact Name Description
Purpose The Texas Employment Verification form is used by employers to verify the employment status and income of individuals applying for state benefits.
Governing Law This form is governed by Texas state law, particularly regulations related to employment verification for state assistance programs.
Submission Methods Employers can return the completed form by giving it to the employee, mailing it in a pre-paid envelope, or faxing it to the designated number.
Contact Information For assistance, individuals can call 2-1-1 or 877-541-7905. Additional support is available for those who are deaf or hard of hearing by calling 7-1-1 or 800-735-2989.

Guide to Using Texas Employment Verification

Completing the Texas Employment Verification form is an important step in the process of verifying employment status. This form requires both the employee and employer to provide specific information. Once the form is filled out, it should be returned to the appropriate agency to assist in determining eligibility for state benefits.

  1. Begin by entering your Name and Address at the top of the form.
  2. Next, fill in the Date on which you are completing the form.
  3. Provide the Case Name and Case Number as indicated on the form.
  4. In the section labeled "Fill Out and Sign This Agreement," print your name where indicated.
  5. Agree to allow the Texas Health and Human Services Commission (HHSC) to share your Social Security number (SSN) with your employer by checking the appropriate box.
  6. Sign and date the agreement to confirm your consent.
  7. Next, the employer will need to complete the section titled "Proof of Employment." They should provide their Company or Employer Address.
  8. The employer must fill in your Employee Name and Employee Address as recorded in their records.
  9. Indicate whether you are or were employed by the employer by checking "Yes" or "No." If "No," the employer should stop here, sign, and date the bottom of the form.
  10. If "Yes," the employer must answer all subsequent questions, marking "N/A" for any that do not apply.
  11. Provide details regarding your Rate of Pay and how often you are paid.
  12. Indicate the Average Hours Per Pay Period and any additional compensation such as commissions, tips, or bonuses.
  13. Answer questions regarding health insurance availability and whether you are enrolled.
  14. Fill in the Date Hired and the Date First Check Received.
  15. If applicable, provide information about any leave without pay, including start and end dates.
  16. Complete the section regarding any expected changes to the information provided.
  17. List all wages received during the specified month(s) in the chart provided.
  18. In the comments section, clarify any details regarding tips, commissions, or bonuses.
  19. If you are no longer employed, the employer should fill in the Date Separated and Reason for Separation.
  20. Finally, the employer must sign and date the form, confirming the information is true and correct to the best of their knowledge.

After completing these steps, the form can be returned to the Texas Health and Human Services Commission using one of the provided methods: giving it to the employee, mailing it in the pre-paid envelope, or faxing it to the specified number. This ensures that the verification process continues smoothly.

Get Answers on Texas Employment Verification

What is the Texas Employment Verification form?

The Texas Employment Verification form is a document used to confirm an individual's employment status. It is typically filled out by the employer to provide necessary information about an employee or former employee to the Texas Health and Human Services Commission (HHSC). This form is essential for individuals applying for state benefits.

Who needs to fill out this form?

Employers are responsible for completing the Texas Employment Verification form. If you are an employee or a former employee applying for state benefits, your employer must provide proof of your employment status by filling out this form.

What information does the employer need to provide?

The employer must provide various details, including:

  • Company name and address
  • Employee's name and address
  • Employment status (full-time, part-time, temporary, etc.)
  • Rate of pay
  • Average hours worked per pay period
  • Health insurance availability
  • Any additional comments regarding the employee's compensation

How should the employer submit the completed form?

Once the employer has filled out the form, they can submit it in one of three ways:

  1. Give it directly to the employee.
  2. Mail it using the pre-paid envelope provided.
  3. Fax it to 877-447-2839.

What if a question does not apply to the employee?

If a question does not apply, the employer should mark it with "N/A." This helps clarify which sections are relevant to the employee's situation and ensures the form remains clear and concise.

What happens if the employee is no longer with the company?

If the employee is no longer employed, the employer should indicate the date of separation and the reason for it on the form. This information is crucial for the HHSC to understand the employee's current status.

Is the information provided on the form confidential?

Yes, the information shared on the Texas Employment Verification form is treated as confidential. It is used solely for the purpose of verifying employment for state benefits and is protected under privacy laws.

Where can I get help if I have questions about the form?

If you need assistance, you can call 2-1-1 or 877-541-7905 for help. For those who are deaf, hard of hearing, or speech impaired, you can reach out by calling 7-1-1 or 800-735-2989. All these numbers are free to call.

Common mistakes

Filling out the Texas Employment Verification form can be a straightforward process, yet many individuals encounter common mistakes that can lead to delays or complications. Understanding these pitfalls can help ensure a smoother experience for both employees and employers.

One frequent error is failing to provide complete and accurate contact information for both the employee and the employer. It is crucial to include the correct names, addresses, and phone numbers. Omitting or misspelling any of this information can hinder communication and may result in processing delays.

Another mistake is neglecting to sign the form. The signature is a vital component that confirms consent for the release of information. Without it, the form may be considered incomplete, leading to unnecessary setbacks in the verification process.

Individuals often forget to check the appropriate employment status. Indicating whether the employee is full-time, part-time, permanent, or temporary is essential. Misclassifying the employment type can lead to incorrect assumptions about the employee's eligibility for certain benefits.

Additionally, failing to provide accurate pay details is a common oversight. Employers must list the correct rate of pay and how often the employee is paid. Inaccurate financial information can affect the assessment of benefits and entitlements.

Some individuals mistakenly leave questions unanswered, particularly those that may not apply. It is important to mark these questions with "N/A" to indicate that they were considered. Leaving them blank can create confusion and may lead to delays in processing.

Another area where errors occur is in reporting the employee's insurance status. Employers should clearly indicate whether health insurance is available and the employee's enrollment status. Miscommunication about health benefits can lead to complications for the employee seeking assistance.

Moreover, not providing a clear reason for separation when applicable is a significant mistake. This information is necessary for understanding the context of the employee's status and can impact future benefits. Clarity in this section helps to avoid misunderstandings.

Lastly, some may overlook the importance of the comments section. This area allows for additional information that can clarify any irregularities or provide context about the employee's pay structure. Utilizing this section can be beneficial in ensuring all relevant details are communicated effectively.

By being mindful of these common mistakes, both employees and employers can contribute to a more efficient and accurate employment verification process. Attention to detail and clear communication are essential in navigating this important documentation.

Documents used along the form

The Texas Employment Verification form is a crucial document for employers and employees alike, often used in various situations where proof of employment is required. Along with this form, several other documents may be needed to provide a comprehensive view of an employee's status and history. Below is a list of commonly associated forms and documents.

  • W-2 Form: This form reports an employee's annual wages and the amount of taxes withheld from their paycheck. It is essential for tax purposes and is typically issued by employers at the end of each tax year.
  • Pay Stubs: Pay stubs provide detailed information about an employee's earnings for a specific pay period. They include gross pay, deductions, and net pay, serving as proof of income for various applications.
  • Offer Letter: An offer letter outlines the terms of employment, including job title, salary, and start date. This document is often used to verify employment history and conditions.
  • Employment Contract: An employment contract is a formal agreement between an employer and employee detailing job responsibilities, salary, benefits, and termination conditions. It serves as a legal record of the employment arrangement.
  • IRS Form 4506-T: This form allows individuals to request a transcript of their tax return from the IRS. It can be used to verify income and employment history when applying for loans or benefits.
  • Social Security Earnings Statement: This document provides a summary of an individual's earnings as reported to the Social Security Administration. It can help verify employment history and income over time.

Each of these documents plays a significant role in establishing employment status and verifying income. When combined with the Texas Employment Verification form, they create a clearer picture of an individual's work history, which is often necessary for financial or legal purposes.

Similar forms

The Texas Employment Verification form serves a specific purpose in confirming an individual's employment status and income. Several other documents share similarities with this form in terms of their function and structure. Here’s a list of six such documents:

  • W-2 Form: This document is used by employers to report annual wages and tax withholdings for employees. Like the Texas Employment Verification form, it requires employer input and is essential for verifying income for tax purposes.
  • Pay Stubs: Pay stubs provide detailed information about an employee's earnings over a specific pay period. Similar to the Texas Employment Verification form, they include information about wages, hours worked, and deductions, helping to verify employment and income.
  • Employment Verification Letter: This letter is typically issued by an employer to confirm an employee's job title, salary, and employment duration. It serves a similar purpose to the Texas Employment Verification form, providing proof of employment for various applications.
  • Form I-9: The I-9 form is used to verify an employee's identity and eligibility to work in the United States. While its primary focus is on identity verification, it also requires employer input and is a key document in the employment process, akin to the Texas Employment Verification form.
  • Social Security Administration (SSA) Verification: This document is used to confirm an individual's earnings history and is often required for benefits applications. Like the Texas Employment Verification form, it provides essential information about an individual's employment history and income.
  • Unemployment Benefits Verification Form: This form is used to verify an individual's employment status when applying for unemployment benefits. It shares similarities with the Texas Employment Verification form by requiring employer confirmation of employment status and income details.

Each of these documents plays a vital role in verifying employment and income, helping individuals access benefits or fulfill legal requirements. Understanding their similarities can simplify the process of gathering necessary documentation.

Dos and Don'ts

When filling out the Texas Employment Verification form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here is a list of things to do and avoid:

  • Do ensure all information is accurate and complete. Double-check names, addresses, and dates.
  • Do mark any questions that do not apply with "N/A" to avoid confusion.
  • Do return the form promptly using one of the specified methods: in person, by mail, or via fax.
  • Do keep a copy of the completed form for your records.
  • Don't leave any required fields blank. This may delay processing.
  • Don't provide false or misleading information. This can lead to serious consequences.
  • Don't forget to sign and date the form. An unsigned form will not be accepted.
  • Don't submit the form without verifying that all calculations, especially regarding wages, are correct.

Misconceptions

Misconceptions about the Texas Employment Verification form can lead to confusion and delays in processing. Here are ten common misconceptions, clarified for better understanding:

  • This form is optional for employers. Some employers believe they can choose whether to complete the form. In reality, it is required when an employee is applying for state benefits.
  • Only current employees need verification. Employers must provide verification for both current and former employees, as the form serves to confirm past employment details.
  • Employers can ignore non-applicable questions. Employers should mark questions that do not apply with "N/A." Leaving them blank can lead to processing delays.
  • Personal information is not protected. The form requires sensitive information, including Social Security numbers. This information is protected under privacy laws and used solely for verification purposes.
  • Employers can refuse to provide information. Employers are obligated to complete the form accurately and return it promptly. Refusal can hinder the employee's access to necessary benefits.
  • Verification is only about salary. The form collects various employment details, including job type, hours worked, and additional compensation like bonuses and tips.
  • There are no consequences for inaccurate information. Providing false information can lead to penalties for the employer and affect the employee's benefits eligibility.
  • Employers can submit the form in any format. The Texas Employment Verification form must be completed as provided and returned through the specified methods: mail, fax, or in person.
  • Only the employee can submit the form. While the employee initiates the process, the employer must complete and return the form directly to the Texas Health and Human Services Commission.
  • The form is only for state benefits. While primarily used for state benefits, the verification may also assist in tax credit applications for employers, making it beneficial for both parties.

Understanding these misconceptions is crucial for both employees and employers to ensure a smooth verification process and timely access to benefits.

Key takeaways

Filling out the Texas Employment Verification form is an important process for both employees and employers. Here are some key takeaways to keep in mind:

  • Purpose of the Form: The Texas Employment Verification form is designed to verify the employment status of individuals who are applying for state benefits.
  • Employer's Responsibility: Employers must complete the form accurately and return it promptly. This includes providing details about the employee's job status and compensation.
  • Employee Consent: Employees must agree to allow their employers to share their employment information. This consent is a crucial step in the process.
  • Information Required: Employers need to provide specific details such as the employee's rate of pay, hours worked, and any benefits received.
  • Submission Options: The completed form can be returned in several ways: given directly to the employee, mailed in a pre-paid envelope, or faxed to the designated number.
  • Accuracy is Key: It is essential that all information provided on the form is accurate. Employers should double-check their entries to avoid delays in processing.
  • Contact Information: If assistance is needed, individuals can reach out to the Texas Health and Human Services Commission through the provided phone numbers.

Understanding these points can help ensure that the employment verification process goes smoothly for everyone involved.