Verification Of Employment




Date: ________________

Applicant’s Name: ____________________________________________ Last 4 of SS# _______

Currently employed by_____________________________ Applicant’s work phone # _______________

Address: ___________________________________ City, St, Zip:_______________________________

Full Name of Contact: ___________________________________ Contact’s Ph: ___________________

My employment dates: From: ___/___/______    To: ___/___/_______ Fax _______________________


If employed less than two years with current employer please complete this section


Previously employed by______________________________ Applicant’s work ph # ________________

Address: ___________________________________City, St, Zip:_______________________________

Full Name of Contact: _______________________________ Contact’s Ph: ____________ ext ______

My employment dates: From: ___/___ /______    To: ___/___/______ Fax _____________________


I authorize Realty Ambassadors to contact my current and previous Employers for the purpose of verifying my employment history. I authorize my current/previous Employer to provide Realty Ambassadors and or its representatives any all information requested regarding my employment history, my conduct and compensation. I indemnify and hold harmless Realty Ambassadors and its representatives and my Employer, and its representatives in connection with any and all information provided by my Employer to Realty Ambassadors.



Applicant’s Signature: ___________________________________________________ Date: ________





Employer Please Complete

Name of Company: __________________________________ Employee’s title ____________________

Are you the current ______ or previous ______ Employer? Please check one

Person Verifying: _______________________________ ID: _________ Phone: ____________ Ext.____

Date of hire: ___/___/_____    FT_____PT:_____ Probation _______Date terminated: ____/___/_______

Is the Employee under contract: Y _____ N _____ If yes Date contract expires ____/____/_________

Wage/salary: ________ per Yr. Mo. Wk. Hr. please circle one. If per Hr. how many hours per week ____

Is this commission pay? Y____ N ___ Contract Labor? Y__   N__ Bonus per yr ______ per mo. _______

If previous Employer, would you hire this Employee again: Y ____ N _____ N/A ____

Reason for leaving:____________________________________________________________________

Comments: __________________________________________________________________________





Verified by: Signature _______________________ Title_______________ Date Verified: ___/___/____


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