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The Texas Employment Verification form serves as a crucial document in the process of applying for state benefits. This form is primarily designed for employers to provide essential information about their current or former employees. It requires the employer to confirm whether the individual in question is or was employed, detailing the nature of their employment, such as job type and employment status—whether full-time, part-time, permanent, or temporary. Additionally, the form collects important financial data, including the employee's rate of pay, hours worked, and any additional earnings such as commissions or bonuses. Employers are also asked to indicate if health insurance is available to the employee and to provide details about any leave without pay. The completion of this form is not only a requirement for the employer but also a necessary step for the employee in securing state benefits. It includes a section where the employee must consent to the sharing of their Social Security number with the employer for verification purposes. Clear instructions are provided for submitting the form, whether by mail, fax, or directly to the employee, ensuring that the process is straightforward for all parties involved. Furthermore, the form includes a section for employers to comment on any expected changes in employment status, which can be vital for the assessment of benefits eligibility.

Form Sample

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.

 

 

 

 

 

 

 

 

 

 

 

 

Document Specifications

Fact Name Details
Form Purpose The Texas Employment Verification Form is designed for employers to verify the employment status and income of an employee or former employee.
Governing Law This form is governed by Texas state law, specifically related to employment verification for public assistance programs.
Required Information Employers must provide details such as the employee's name, Social Security number, job type, and rate of pay.
Submission Methods Employers can submit the completed form by mailing it, faxing it, or giving it directly to the employee.
Confidentiality Agreement Employees must consent to allow their Social Security number to be shared with the employer for verification purposes.
Contact Information For assistance, individuals can call 2-1-1 or 877-541-7905, or reach out via fax at 877-447-2839.
Proof of Employment Employers must fill out the "Proof of Employment" section, confirming whether the individual is or was employed and detailing their job status.
Employee Benefits Employers may need to disclose information regarding employee benefits, including health insurance and retirement plans.

Steps to Filling Out Texas Employment Verification

After completing the Texas Employment Verification form, the employer must return it promptly. The information provided will assist in verifying employment for an individual applying for state benefits. Follow the steps below to ensure accurate and complete submission of the form.

  1. Begin by entering your Name and Address at the top of the form.
  2. Fill in the Date on which you are completing the form.
  3. Provide the Case Name and Case No. related to the employment verification.
  4. In the section labeled Employee or Former Employee, print your name to authorize the release of your Social Security number (SSN) to the employer.
  5. Sign and date the agreement to allow the employer to share employment details with HHSC.
  6. The employer must complete the Proof of Employment section, including their Company or Employer Address.
  7. In the Employee Name section, enter the name of the employee as it appears in your records.
  8. Provide the Employee Address as shown in your records.
  9. Indicate if the employee is or was employed by checking Yes or No.
  10. If employed, specify the type of job (Full Time, Part Time, Permanent, Temporary).
  11. Complete the Rate of Pay section, detailing how much the employee earns.
  12. Indicate how often the employee is paid (e.g., weekly, bi-weekly).
  13. Provide information about Average Hours Per Pay Period.
  14. List any additional compensation such as commissions, tips, or bonuses.
  15. Indicate whether health insurance is available and the name of the insurance company.
  16. Fill in the Date Hired and Date First Check Received.
  17. If the employee has been on leave without pay, provide the Start Date and End Date.
  18. Answer whether any changes to the above information are expected in the next few months.
  19. Complete the chart detailing all wages received by the employee during the specified month(s).
  20. If the employee is no longer with the company, provide the Date Separated and Reason for Separation.
  21. Finally, the employer must sign and date the form, confirming that the information provided is accurate.

Once the form is completed, it can be returned to the Texas Health and Human Services Commission through one of the following methods: give it to the employee, mail it using the pre-paid envelope, or fax it to the designated number. Ensure all information is accurate to avoid delays in processing.

More About 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 primarily filled out by employers to provide necessary information about an employee or former employee to the Texas Health and Human Services Commission (HHSC). This verification is often needed for individuals applying for state benefits.

Who needs to fill out the form?

The form must be completed by the employer of the individual seeking state benefits. It requires the employer to provide details about the employee’s job, pay, and employment status. It is essential for the employer to understand the purpose of the form, as it helps the employee access the benefits they may be entitled to.

What information does the employer need to provide?

Employers must provide a variety of details, including the employee's name, address, job type, rate of pay, and employment dates. They also need to indicate whether the employee is currently employed, the average hours worked, and any additional compensation like bonuses or commissions. If the employee is no longer with the company, the employer must include the reason for separation and the date of the final paycheck.

How should the employer return the completed form?

Once the employer has filled out the form, they can return it in several ways. They can hand it back to the employee, mail it using the provided pre-paid envelope, or fax it to the specified number, 877-447-2839. It is crucial that the form is returned promptly to avoid delays in the employee’s benefits application process.

What if a question on the form doesn’t apply to the employee?

If any question on the form does not apply to the employee, the employer should indicate this by marking it as "N/A." This helps ensure that the form is clear and that all relevant information is provided without unnecessary confusion.

Is the employee's Social Security number required on the form?

Yes, the employee must consent to the employer providing their Social Security number (SSN) to the HHSC. This number is essential for verifying employment and accessing relevant employment records. The employee must sign the agreement section of the form to allow this exchange of information.

What if the employer is unable to confirm employment?

If the employer cannot confirm that the individual is or was employed, they should simply stop completing the form after indicating "No" to the employment question. They must then sign and date the bottom of the form and return it as instructed. This helps maintain transparency and ensures that the HHSC receives accurate information.

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

If you have questions or need assistance with the Texas Employment Verification form, you can call the helpline at 2-1-1 or 877-541-7905. These numbers are free to call, and help is available for those who are deaf, hard of hearing, or speech impaired by dialing 7-1-1 or 800-735-2989. It’s important to seek clarification to ensure the form is completed correctly.

Common mistakes

  1. Missing Required Information: One common mistake is failing to fill out all required fields. The form asks for specific details like the employee's name, Social Security number, and employment status. Omitting any of this information can delay the verification process.

  2. Incorrect Job Classification: Employers sometimes misclassify the type of job the employee held. Whether the job was full-time, part-time, temporary, or permanent must be accurately indicated. Misclassification can lead to incorrect benefits being calculated.

  3. Not Providing Accurate Pay Information: It's crucial to report the correct rate of pay and how often the employee is paid. Errors in this section can affect the employee's eligibility for state benefits, leading to complications down the line.

  4. Failure to Sign and Date: Lastly, many employers forget to sign and date the form before submission. This oversight can render the entire form invalid and necessitate resubmission, wasting time for both the employer and the employee.

Documents used along the form

When seeking employment verification in Texas, several other forms and documents may be required alongside the Texas Employment Verification form. Each of these documents serves a specific purpose in the verification process, ensuring that accurate information is provided to the relevant authorities.

  • Proof of Employment Form: This form is often filled out by the employer to confirm the employee's job status, including details such as job title, employment dates, and pay rate.
  • W-2 Form: This document summarizes an employee's annual wages and the taxes withheld from their paycheck. It is essential for verifying income and employment history.
  • Pay Stubs: Recent pay stubs provide a detailed account of an employee's earnings over a specific period. They can help verify current income levels and employment status.
  • Tax Returns: Personal tax returns may be requested to provide a comprehensive view of an individual's income over the past years, further confirming employment details.
  • Employment Offer Letter: This letter outlines the terms of employment, including job title, salary, and start date, serving as proof of the employment agreement.
  • Separation Notice: If an employee has left a job, this document can provide information about the reason for separation and the final paycheck details.
  • Background Check Authorization: This form allows employers to conduct background checks, which may include verification of previous employment and criminal history.
  • Social Security Number Verification: A document that confirms an individual's Social Security number can assist in ensuring that the employment verification process is accurate.
  • Reference Letters: Letters from previous employers or colleagues can provide additional context about an employee’s work history and character.
  • State Benefit Application: This document may be required if the employment verification is related to a state benefits application, linking employment status to eligibility for assistance.

Collectively, these forms and documents help create a clear picture of an individual's employment history and income, which is often crucial for various applications, including state benefits, loans, or housing. Ensuring that all necessary documentation is accurate and complete can streamline the verification process and facilitate a smoother experience for all parties involved.

Similar forms

The Texas Employment Verification form is similar to the Federal Employment Verification form (I-9). Both documents serve the purpose of verifying an employee's employment status and eligibility. The I-9 requires employers to confirm the identity and work authorization of their employees, while the Texas form focuses on providing information about the employee's wages and employment duration. Both forms require the employer's signature, affirming the accuracy of the provided information.

Another document that shares similarities is the W-2 form. The W-2 is issued by employers to report an employee's annual wages and tax withholdings to the IRS. Like the Texas Employment Verification form, it requires detailed information about the employee's earnings and is used to verify employment for tax purposes. Both documents are essential for ensuring compliance with state and federal regulations regarding employment and taxation.

The Social Security Administration's (SSA) Employment Verification Request is also comparable. This document is used to confirm an individual's employment history for Social Security benefits. Both the SSA request and the Texas Employment Verification form require the employer to provide specific employment details, such as the employee's start date and earnings. They both help ensure that individuals receive the correct benefits based on their employment history.

The Unemployment Insurance Benefit Claim form is another similar document. Individuals applying for unemployment benefits must provide proof of their previous employment. The Texas Employment Verification form can serve as supporting documentation for this claim. Both forms aim to establish the applicant's work history and earnings, which are critical for determining eligibility for unemployment benefits.

The Workers' Compensation Claim form also bears resemblance to the Texas Employment Verification form. When an employee files a claim for workplace injuries, they must provide proof of employment and earnings. The Texas form can assist in verifying this information, as both documents require details about the employee's job and income. They are both vital for ensuring that claims are processed accurately and fairly.

Lastly, the Employee Reference Request form is similar in that it seeks to verify employment details. This form is often used by prospective employers to confirm an applicant's previous job titles, dates of employment, and performance. Like the Texas Employment Verification form, it requires the current or former employer to provide accurate employment information, ensuring that the applicant's work history is verified before hiring decisions are made.

Dos and Don'ts

When filling out the Texas Employment Verification form, it’s important to follow certain guidelines to ensure accuracy and compliance. Here’s a list of what you should and shouldn’t do:

  • Do print clearly to avoid any confusion.
  • Do include all required information, such as the employee's name and Social Security number.
  • Do answer all questions honestly to maintain integrity.
  • Do mark any questions that do not apply with "N/A."
  • Do return the form promptly to avoid delays in processing.
  • Don’t leave any fields blank unless they are not applicable.
  • Don’t provide false information, as this can lead to legal consequences.
  • Don’t forget to sign and date the form before submission.
  • Don’t use abbreviations or shorthand that may confuse the reader.
  • Don’t hesitate to contact the provided numbers if you have questions or need assistance.

Misconceptions

Understanding the Texas Employment Verification form can be challenging. Here are five common misconceptions that need clarification:

  • Only current employees need to be verified. Many believe that this form is only for current employees. However, it can also be used for former employees who are applying for state benefits.
  • The form is optional for employers. Some employers think that completing this form is optional. In reality, it is a requirement for employers to provide this information when requested by the Texas Health and Human Services Commission.
  • Employers can refuse to fill out the form. There is a misconception that employers can refuse to complete the form if they do not want to share information. If the employee has provided consent, employers are obligated to fill it out accurately.
  • All questions on the form must be answered. Many people think that every question on the form must be answered. If a question does not apply, employers can simply mark it as "N/A" instead of leaving it blank.
  • Information shared is not protected. Some individuals worry that their personal information will not be kept confidential. In fact, the information provided is protected and used solely for the purpose of verifying employment for state benefit applications.

It is essential to address these misconceptions to ensure a smooth verification process. Understanding the requirements can help both employers and employees navigate this important form more effectively.

Key takeaways

When filling out and using the Texas Employment Verification form, consider the following key takeaways:

  • Purpose of the Form: This form is primarily used by employers to verify the employment status of individuals applying for state benefits.
  • Consent Requirement: Employees must provide consent for their employers to share their employment information, including their Social Security number, with the Texas Health and Human Services Commission (HHSC).
  • Filling Out the Form: Employers should complete the "Proof of Employment" section accurately. If a question does not apply, they should indicate this by writing "N/A."
  • Submission Options: 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.
  • Accuracy is Crucial: Employers must ensure that all information provided is true and correct. Any inaccuracies could lead to complications for the employee seeking benefits.