Ccis Employment Verification PDF Template

Ccis Employment Verification PDF Template

The CCIS Employment Verification Form is a crucial document used to confirm an employee's work status and income. This form assists in determining eligibility for subsidized child care programs. To ensure accurate processing, it must be completed by an authorized company representative and submitted directly to the Early Learning Resource Center (ELRC).

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Article Guide

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 employee and the employer to ensure accuracy and compliance. Employers must provide essential details such as their name, address, and contact information, along with the employee's job title and employment status. The form asks whether the employee is newly hired, their employment start date, and their income details, including hourly rate and gross pay. Additionally, it captures the employee's work schedule over a four-week period, detailing the days and hours worked. If applicable, the form also addresses extended leave situations and temporary or seasonal employment status. An authorized company representative, not the employee, must complete the form and submit it directly to the Early Learning Resource Center (ELRC). This verification process is vital for ensuring that child care support reaches those who truly qualify.

Ccis Employment Verification Preview

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
Employment Verication Form
CY 925 6/19
Employment Verication 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 specic and dened 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:
CY 925 6/19
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

File Properties

Fact Name Description
Purpose The Ccis Employment Verification Form is designed to verify employment details for employees seeking subsidized child care assistance.
Authorization Employees must authorize the release of their employment information, allowing the Early Learning Resource Center (ELRC) to verify the details provided.
Employer Information Employers must complete sections that include their identification number (EIN), address, and contact information.
Employee Details Key employee information such as job title, employment start date, and income details must be accurately filled out by the employer.
Work Schedule Employers are required to provide a detailed work schedule, indicating the specific days and hours worked, along with whether the hours are in A.M. or P.M.
Extended Leave The form includes a section to indicate if the employee is on extended leave, with dates for the beginning and return from leave.
State-Specific Regulations In Pennsylvania, the governing law for employment verification related to subsidized child care is the Child Care Development Block Grant (CCDBG) Act.

Instructions on Utilizing Ccis Employment Verification

Once the Ccis Employment Verification form is completed, it will be submitted to the Early Learning Resource Center (ELRC). This step is crucial for determining the employee's eligibility for subsidized child care. Ensure that all information is accurate and clearly presented to facilitate the verification process.

  1. Begin by entering the Employer Name/Place of Employment.
  2. Fill in the Immediate Supervisor’s Name.
  3. Provide the Immediate Supervisor’s Title.
  4. Authorize the release of information by signing and dating the section titled Employee’s Printed Name, Employee’s Signature, and Date.
  5. In the section for the employer, enter the Employer Identification Number (EIN).
  6. Fill out the Address of Employment.
  7. Provide the Employer’s Telephone Number.
  8. In the Employee Information section, write the Employee’s Job Title.
  9. Indicate whether the employee is newly hired by selecting Yes or No.
  10. Enter the Employment Start Date in the format of MM/DD/YYYY.
  11. Fill in the Hourly Rate, Gross Pay, and Average Daily Tips.
  12. Specify the Next Pay Date and Pay Frequency (Weekly, Bi-Weekly, Twice a Month, Monthly).
  13. Indicate the employee's pay status by checking the appropriate boxes for receives paystubs, does NOT receive paystubs, receives pay in CASH, or has access to pay online.
  14. Complete the Employment Schedule section by detailing the days and hours the employee works. If the schedule varies, provide a 4-week sample schedule.
  15. For each week, fill in the Dates, Monday through Sunday hours, and the Total # Hours/Week.
  16. If applicable, fill out the section for Extended Leave, indicating whether the employee is on leave and providing relevant dates.
  17. Complete the Temporary/Seasonal Employment section if applicable, indicating if the employee is a temporary hire and providing the last date of guaranteed employment.
  18. Finally, print and sign the Employer’s Printed Name & Job Title, and provide the Employer’s Signature and Date.

Important Facts about Ccis Employment Verification

What is the purpose of the CCIS Employment Verification form?

The CCIS Employment Verification form is used to confirm an employee's job status and income. This verification helps determine if the employee qualifies for subsidized child care assistance. The information provided is crucial for the Early Learning Resource Center (ELRC) to assess eligibility accurately.

Who is responsible for completing the form?

An authorized representative from the employer's organization must complete the form. This person should not be the employee requesting the verification. It ensures that the information is accurate and reliable.

What information is required from the employer?

The employer must provide details such as the employer's name, address, and identification number. Additionally, they need to include the employee's job title, employment start date, income details, and a work schedule. All sections must be filled out completely for the verification to be valid.

How should the work schedule be documented?

The employer should indicate the specific days and hours the employee works, noting whether the hours are in the A.M. or P.M. If the employee's schedule varies, a four-week sample schedule is required to give a clear picture of their typical work hours.

What if the employee is on extended leave?

If the employee is on extended leave, such as maternity or disability leave, the employer must indicate this on the form. They should provide the start date of the leave and the anticipated return date. This information is essential for determining the employee's eligibility for child care assistance.

What if the employee is temporary or seasonal?

If the employee is classified as temporary or seasonal, the employer must specify this on the form. They should also provide the last date of guaranteed employment for temporary hires and the expected return date for seasonal employees. This helps the ELRC assess the employee's ongoing eligibility.

How is the employee’s income reported?

The employer must report the employee's hourly rate, gross pay, and any average daily tips. This information allows the ELRC to evaluate the financial need for child care assistance accurately. Pay frequency, such as weekly or bi-weekly, should also be indicated.

What happens after the form is completed?

Once the form is completed, it must be mailed directly to the Early Learning Resource Center (ELRC). This ensures that the information is received by the appropriate department for processing. The employer's signature and date are also required to validate the form.

Who can I contact for help with the form?

If there are any questions or uncertainties about completing the form, employers can contact the ELRC. The contact information is provided on the form, including phone numbers and a fax number, making it easy to seek assistance when needed.

Common mistakes

Filling out the CCIS Employment Verification form can seem straightforward, but many people make mistakes that can lead to delays or complications in processing. Here are seven common errors to avoid.

First, one of the most frequent mistakes is neglecting to include the Employer Identification Number (EIN). This number is essential for identifying the business and ensuring that the information provided is accurate. Without it, the verification process may stall, causing unnecessary delays for the employee seeking assistance.

Second, many employers forget to provide a complete and accurate employment schedule. It’s crucial to specify the days and hours the employee works, clearly indicating whether the hours are in A.M. or P.M. Vague entries or incomplete schedules can lead to confusion and may require additional follow-up, which can be frustrating for everyone involved.

Another common oversight is failing to check the box indicating whether the employee is a new hire. This detail is important for the Early Learning Resource Center (ELRC) to understand the employee's status. If this section is left unchecked, it may lead to further questions and delays in processing the application.

Fourth, some employers mistakenly provide average daily tips as part of the employment income but do not clarify how they are calculated. This lack of clarity can create misunderstandings about the employee's total earnings, which are critical for determining eligibility for subsidized child care.

Fifth, not signing the form can be a simple yet impactful mistake. The employer’s signature is a necessary confirmation that the information provided is true and accurate. Without this signature, the form may be considered incomplete, resulting in a rejection or delay in processing.

Sixth, employers sometimes overlook the section about extended leave. If an employee is on maternity or disability leave, this information is vital for the ELRC to assess eligibility accurately. Failing to mention this can lead to incorrect assumptions about the employee's current work status.

Finally, many people do not provide a 4-week sample schedule when the employee’s hours vary from week to week. This oversight can complicate matters, as the ELRC needs a clear understanding of the employee's work patterns to make an informed decision regarding assistance.

By being mindful of these common mistakes, employers can help ensure that the CCIS Employment Verification form is completed accurately and efficiently, ultimately benefiting both the employee and the organization.

Documents used along the form

The CCIS Employment Verification form is an essential document for verifying an employee's work status and income. Alongside this form, several other documents may be required to complete the verification process or provide additional context regarding the employee's situation. Below is a list of related forms and documents that are commonly used.

  • Pay Stubs: These are regular statements provided by employers detailing an employee's earnings, deductions, and net pay for a specific pay period. Pay stubs help verify income and employment status.
  • W-2 Form: This form summarizes an employee's annual earnings and taxes withheld. Employers must provide this to employees by January 31 each year, making it a useful document for verifying income over a full year.
  • Employment Contract: This document outlines the terms of employment, including job responsibilities, salary, and duration of employment. It serves as a formal agreement between the employer and employee.
  • IRS Form 1099: For independent contractors or freelancers, this form reports income received from non-employer sources. It is crucial for verifying income for those not on a traditional payroll.
  • Social Security Card: This card provides proof of an employee's Social Security number, which is often required for tax and employment verification purposes.
  • Driver's License or State ID: A government-issued identification card can serve to verify the identity of the employee, ensuring the accuracy of the information provided.
  • Background Check Authorization Form: This form allows employers to conduct background checks on employees, providing additional context regarding an employee's history and qualifications.
  • Verification of Employment (VOE) Letter: This letter is typically issued by the employer and confirms the employee's job title, salary, and duration of employment. It serves as an official document for verification purposes.

Each of these documents plays a vital role in the employment verification process. Together, they help create a comprehensive picture of an employee's work history, income, and identity, ensuring that all necessary information is accurately assessed.

Similar forms

  • W-2 Form: Similar to the Ccis Employment Verification form, the W-2 form provides details about an employee's earnings and taxes withheld. Both documents serve as official records for employment income, though the W-2 is typically used for tax reporting purposes.
  • Pay Stubs: Pay stubs offer a breakdown of an employee's earnings for a specific pay period, including deductions. Like the Ccis form, pay stubs confirm employment status and income, but they are issued more frequently, often with each paycheck.
  • Employment Offer Letter: This document outlines the terms of employment, including job title and salary. Both the offer letter and the Ccis form verify employment details, but the offer letter is provided at the start of employment, while the Ccis form is used for ongoing verification.
  • Verification of Employment (VOE) Letter: A VOE letter is a formal document from an employer confirming an employee's job title, dates of employment, and salary. It serves a similar purpose as the Ccis form, as both are used to validate employment for various applications.
  • IRS Form 1099: This form is issued to independent contractors and freelancers to report income received. While the Ccis form is for employees, both documents provide verification of income, but the 1099 is typically used for tax purposes for non-employees.
  • Job Description: A job description outlines the responsibilities and requirements of a specific position. Like the Ccis form, it provides clarity on job roles, but the job description is more focused on duties rather than employment verification.
  • Employee Handbook: This document contains company policies and procedures, including information on employment status. While the Ccis form specifically verifies employment for eligibility purposes, the employee handbook provides broader context about the workplace environment.

Dos and Don'ts

Filling out the CCIS Employment Verification form correctly is essential for ensuring that your employee receives the assistance they need for subsidized child care. Here are some important dos and don'ts to keep in mind while completing the form.

  • Do ensure all required fields are filled out completely.
  • Do provide accurate and specific information regarding the employee’s work schedule.
  • Do include the employer identification number (EIN) to avoid delays.
  • Do have an authorized company representative sign the form, not the employee.
  • Don't leave any sections blank; incomplete forms may be returned.
  • Don't estimate hours; provide exact times and specify A.M. or P.M.
  • Don't forget to include the average daily tips if applicable.
  • Don't submit the form without double-checking for accuracy.

By following these guidelines, you can help ensure a smooth verification process for your employee's subsidized child care application.

Misconceptions

  • Misconception 1: The CCIS Employment Verification form is only for full-time employees.

    This form is applicable to both full-time and part-time employees. It verifies employment status regardless of the hours worked.

  • Misconception 2: Employers can complete the form without specific details about the employee's schedule.

    Specific details are crucial. Employers must provide accurate work schedules, including hours and whether they are A.M. or P.M.

  • Misconception 3: The form can be submitted by the employee.

    Only an authorized company representative can complete and submit the form. This ensures the information is verified and accurate.

  • Misconception 4: The information on the form is not confidential.

    The details provided are confidential and used solely to determine eligibility for subsidized child care. Privacy is maintained throughout the process.

Key takeaways

When filling out and using the CCIS Employment Verification form, keep the following key takeaways in mind:

  • Accurate Information is Crucial: Ensure that all sections are filled out accurately. This includes the employer's identification number, employee's job title, and employment income.
  • Specify Work Hours: Clearly indicate the employee's work schedule, including specific times for each day. Use A.M. and P.M. to avoid any confusion.
  • Sample Schedule for Variable Hours: If the employee's schedule changes week to week, provide a 4-week sample schedule. This helps the Early Learning Resource Center (ELRC) understand the employee's typical work pattern.
  • Authorized Signature Required: An authorized company representative must complete and sign the form. The employee cannot sign this form themselves.
  • Submit Directly to ELRC: Once completed, the form must be mailed directly to the Early Learning Resource Center. Do not send it through the employee.