Article Structure
The CCIS Employment Verification Form plays a crucial role in determining an employee's eligibility for subsidized child care assistance. This form requires the employer to provide detailed information about the employee's job title, employment start date, and income details, including hourly rates and gross pay. Additionally, it asks for the employee's work schedule, requiring specifics on days and hours worked, clearly indicating whether these hours occur in the A.M. or P.M. Employers must also confirm whether the employee is newly hired, on extended leave, or classified as temporary or seasonal. The form necessitates the employer's identification number and contact details, ensuring a reliable means of verification. By signing the form, employers authorize the Early Learning Resource Center (ELRC) to verify the information provided. This process not only aids in assessing eligibility for child care subsidies but also streamlines communication between the employer and the ELRC, fostering an efficient verification process.
Form Sample
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 Verication Form
CY 925 6/19
Employment Verication 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 specic and dened 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
Document Specifications
| Fact Name | Description |
|---|---|
| Purpose | The Ccis Employment Verification form is used to verify an employee's employment status and income for eligibility in subsidized child care programs. |
| Completion Requirement | The form must be completed by an authorized company representative, not the employee, to ensure the accuracy of the information provided. |
| Information Collected | It collects various details, including the employee's job title, employment start date, income, and work schedule. |
| Governing Law | In Pennsylvania, the form is governed by regulations related to child care subsidy programs under the Pennsylvania Department of Human Services. |
Steps to Filling Out Ccis Employment Verification
Completing the CCIS Employment Verification form is a straightforward process that requires accurate information about the employee's job and income details. Once the form is filled out correctly, it should be submitted directly to the Early Learning Resource Center (ELRC) for processing. This step is essential for determining the employee's eligibility for subsidized child care assistance.
- Employer Information: Fill in the employer name or place of employment.
- Supervisor Details: Provide the immediate supervisor's name and title.
- Authorization: Have the employee sign and date the authorization section to release their information.
- Employer Identification Number: Enter the Employer Identification Number (EIN).
- Address: Fill in the address of the place of employment.
- Contact Information: Include the employer’s telephone number.
- Employee Information: Write the employee’s job title and indicate if they are newly hired.
- Employment Dates: Specify the employment start date.
- Income Details: Fill in the hourly rate, gross pay, average daily tips, next pay date, and pay frequency.
- Pay Stubs: Indicate whether the employee receives pay stubs, cash payments, or has online access to pay.
- Work Schedule: Provide a detailed work schedule for four weeks, including days, hours, and whether those hours are A.M. or P.M.
- Extended Leave: Answer if the employee is on extended leave and provide relevant dates.
- Temporary/Seasonal Employment: Indicate if the employee is temporary or seasonal, and provide relevant employment dates.
- Employer Certification: The employer must print their name and job title, sign, and date the form.
More 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 information helps determine eligibility for subsidized child care programs. Employers must complete the form to provide accurate details about the employee’s work schedule and income.
Who is responsible for filling out the form?
An authorized company representative, not the employee, must complete the CCIS Employment Verification Form. This ensures that the information provided is accurate and verified by someone in a position of authority within the organization.
What specific information is required from the employer?
The employer must provide several key details, including the employer identification number (EIN), address, and telephone number. Additionally, they need to include the employee’s job title, employment start date, hourly rate, gross pay, and work schedule. If the employee is on leave or considered temporary, that information must also be indicated.
How should the work schedule be documented?
The employer needs to provide a detailed work schedule, indicating the days and hours the employee works. It is important to specify whether the hours are in the A.M. or P.M. If the schedule varies, a four-week sample schedule must be provided to give a clear picture of the employee's typical hours.
What if the employee does not receive paystubs?
If the employee does not receive paystubs, the employer should indicate this on the form. The employer may also need to provide alternative documentation or information about how the employee receives their pay, such as cash payments or online access to pay information.
What happens if the employee is on extended leave?
If the employee is on extended leave, the employer must indicate this on the form and provide the start date of the leave and the expected return date. This information is crucial for determining the employee's eligibility for child care assistance during their absence.
Is there a deadline for submitting the form?
How can employers get assistance with filling out the form?
If employers have questions or need help completing the CCIS Employment Verification Form, they can contact the Early Learning Resource Center (ELRC) directly. The contact information is provided on the form, and assistance is available to ensure accurate completion.
Common mistakes
-
Incomplete Employer Information: Failing to provide all necessary details about the employer, such as the Employer Identification Number (EIN), can lead to delays in processing. Ensure that the employer's name, address, and telephone number are clearly filled out.
-
Ambiguous Work Schedule: Not specifying whether the hours worked are in the A.M. or P.M. can create confusion. It is crucial to provide exact times and, if applicable, a clear four-week sample schedule to avoid misunderstandings.
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Incorrect Income Reporting: Providing inaccurate figures for the employee's income, such as the hourly rate or gross pay, can have significant consequences. Double-check these numbers to ensure they reflect the employee's actual earnings.
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Failure to Sign: The form must be signed by an authorized company representative, not the employee. Neglecting to include the employer's signature can render the form invalid, leading to delays in the employee's application for subsidized child care.
Documents used along the form
When completing the Ccis Employment Verification form, several additional documents may be required to provide a comprehensive understanding of an employee's work situation. These documents help ensure that all necessary information is available for verifying employment and assessing eligibility for child care assistance. Below is a list of commonly used forms and documents that may accompany the Employment Verification form.
- Pay Stubs: Recent pay stubs provide proof of income and employment status. They detail the employee's earnings over a specific period and can help verify the information provided in the Employment Verification form.
- W-2 Forms: The W-2 form summarizes an employee's annual earnings and the taxes withheld. This document is essential for confirming income levels and is often required for financial assessments.
- Job Offer Letter: A job offer letter outlines the terms of employment, including job title, salary, and start date. This document can help establish the employee's position and employment history.
- Tax Returns: Recent tax returns provide a complete picture of an employee's income and financial situation. They can support the information provided in the Employment Verification form and other income-related documents.
- Employer Reference Letter: A reference letter from the employer can affirm the employee's job title, responsibilities, and duration of employment. This letter adds credibility to the employment verification process.
- Schedule of Work Hours: A detailed schedule outlining the employee's work hours can clarify the employee's availability and help in understanding their work commitments, especially if the hours vary.
Collectively, these documents enhance the verification process, ensuring that the employee's information is accurate and complete. Providing thorough documentation not only assists in determining eligibility for child care assistance but also fosters a supportive environment for employees seeking help.
Similar forms
The W-2 form is a crucial document for employees and employers alike. It reports an employee's annual wages and the taxes withheld from their paycheck. Similar to the CCIS Employment Verification form, the W-2 requires employer information, employee identification, and details about earnings. Both forms serve to verify employment and income, often used in applications for financial assistance or benefits.
The pay stub is another document that provides a breakdown of an employee's earnings. It includes details such as gross pay, deductions, and net pay, similar to the income section of the CCIS Employment Verification form. Pay stubs are often used to confirm an employee's current income, making them a useful tool for financial assessments.
The I-9 form is essential for verifying an employee's identity and eligibility to work in the United States. While it does not provide income details, it shares the common purpose of confirming employment status. Like the CCIS form, the I-9 must be completed by both the employee and employer, ensuring accurate information is recorded.
The employment letter serves as a formal document from the employer confirming an individual's job status. It typically includes job title, dates of employment, and salary, paralleling the information required in the CCIS Employment Verification form. Both documents are often requested by financial institutions when individuals seek loans or assistance.
The 1099 form is used for independent contractors and freelancers to report income received. Like the CCIS Employment Verification form, it provides a record of earnings, although it is specifically for non-employees. Both documents play a role in income verification for financial applications.
The payroll summary report provides an overview of an organization's payroll expenses, including total wages paid to employees. This document is similar to the CCIS Employment Verification form in that it contains information about employee compensation and work hours, making it useful for verifying employment income.
The employee contract is a legal agreement that outlines the terms of employment, including salary and job responsibilities. It shares similarities with the CCIS form by detailing the employee's role and compensation. Both documents are important for confirming employment status and understanding the expectations of the job.
The benefits verification form is used to confirm an employee's eligibility for specific benefits offered by their employer. This document is akin to the CCIS Employment Verification form, as both require employer input and serve to verify employee status and eligibility for assistance programs.
The child care subsidy application often requires proof of employment and income, similar to the CCIS Employment Verification form. Both documents are necessary for determining eligibility for financial assistance, ensuring that applicants meet the required criteria for support.
Dos and Don'ts
When filling out the CCIS Employment Verification form, it is important to follow certain guidelines to ensure accuracy and compliance. Here’s a list of things you should and shouldn’t do:
- Do provide complete and accurate information.
- Do ensure that the employer identification number (EIN) is correct.
- Do specify the employee’s job title clearly.
- Do indicate whether the employee is newly hired.
- Don’t leave any required fields blank.
- Don’t provide vague descriptions of the employee’s work schedule.
- Don’t sign the form without verifying all information is accurate.
- Don’t forget to submit the form directly to the Early Learning Resource Center (ELRC).
Misconceptions
Here are four common misconceptions about the Ccis Employment Verification form:
- Only full-time employees need to complete the form. This is not true. The form is required for all employees seeking subsidized child care assistance, regardless of their employment status, whether full-time, part-time, temporary, or seasonal.
- The employee can fill out the entire form themselves. In fact, an authorized company representative, not the employee, must complete the form. This ensures that the information provided is accurate and verified by the employer.
- Submitting the form is optional. It is essential to submit this form for the employee to be considered for subsidized child care assistance. Without it, the application cannot be processed.
- Pay frequency does not need to be specified. The form requires detailed information about the employee's pay frequency, including whether they are paid weekly, bi-weekly, or monthly. This information is crucial for determining eligibility and calculating benefits.
Key takeaways
Ensure that the employer section of the form is completed accurately. This includes the employer's name, address, and contact information.
It is crucial that the employee's job title and employment status (newly hired or not) are clearly indicated. This information helps assess eligibility for child care assistance.
Provide a detailed work schedule for the employee. If the schedule varies, include a four-week sample to give a clear picture of their working hours.
Be specific about the pay frequency and amounts. Include details about the employee's gross pay, hourly rate, and any tips received.
Make sure the signature and date of the authorized company representative are included. This validates the information provided on the form.
Submit the completed form directly to the Early Learning Resource Center (ELRC) as instructed. This step is essential for processing the employee's request for subsidized child care.