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Employment Verification

Verify Parent Employment for Childcare Subsidy Eligibility

Collect employer-certified job, pay, and work schedule details for childcare assistance applicants, plus the parent's authorization to release records.

Use This Template Free Preview

Volt theme

formbuilder.ai/f/childcare-subsidy-program-parent-employment-work-schedule-verification-form

Childcare Subsidy Program Parent Employment & Work Schedule Verification Form

Parent/Applicant Full Name

· · ·

Subsidy Case or Application Numb

· · ·

Employer / Business Name

· · ·

Submit

This Childcare Subsidy Parent Employment and Work Schedule Verification Form Template gives childcare assistance programs a simple, structured way to confirm that applicants meet work requirements. The form has two sections. First, the parent enters their full name, subsidy case or application number, and employer contact details. They then authorize the employer to release employment, earnings, and work schedule information to the program. Next, the employer or an authorized representative, such as HR, payroll staff, or a supervisor, completes the employment section using current payroll and scheduling records.

The template is designed for state and county childcare subsidy offices, human services departments, child care resource and referral agencies, early learning coalitions, and nonprofits that administer childcare assistance. Employers report the parent's job title, start date, employment status, gross hourly pay rate, pay frequency, typical weekly work schedule, average hours worked per week, and schedule type. They can also add details on overtime, tips, commissions, split shifts, or end dates for temporary and seasonal roles. An employer certification section with the authorized representative's name confirms the information is accurate.

Moving this process online replaces faxed paperwork and phone tag with complete, legible submissions that caseworkers can review quickly. Day-by-day schedule details make it easier to calculate authorized childcare hours, and structured fields reduce the missing information that delays eligibility decisions. Customize the questions to fit your program's policies, add your branding, and share a link with parents so families can get the childcare support they need sooner.

3 Pages

20 Questions

~7min To complete

Free Included on every plan

Field types Short Text ×4 Full Name ×2 termsandconditions ×2 Date ×2 Dropdown ×2 Address Phone currency Table / Grid number Single Choice Long Text Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Parent & Employer Information 6 questions

Parent & Employer Information (Completed by Parent)

1 Parent/Applicant Full Name * Full Name

2 Subsidy Case or Application Number * Short Text

3 Employer / Business Name * Short Text

4 Employer Address * Address

5 Employer Phone Number * Phone

6 I authorize the employer listed above to release my employment, earnings, and work schedule information to the Childcare Subsidy Program to determine my eligibility and authorized childcare hours. * termsandconditions

Page 2 Employment, Pay & Work Schedule 9 questions

Employment, Pay & Work Schedule (Completed by Employer)

This section must be completed by the employer or an authorized representative, such as HR, payroll staff, or a supervisor. Please base all information on the employee's current payroll and scheduling records.

1 Employee Job Title / Position * Short Text

2 Employment Start Date * Date

3 Employment Status * Dropdown

4 Gross Hourly Pay Rate (or hourly equivalent if salaried) * currency

5 Pay Frequency * Dropdown

6 Typical Weekly Work Schedule (leave non-working days blank) * Table / Grid

7 Average Hours Worked Per Week * number

8 Work Schedule Type * Single Choice

9 Additional Pay or Schedule Details (overtime, tips/commissions, split shifts, or end date if temporary/seasonal) Long Text

Page 3 Employer Certification 5 questions

Employer Certification

1 Authorized Employer Representative Name * Full Name

2 Representative Job Title * Short Text

3 Date of Verification * Date

4 I certify that I am authorized to provide this verification on behalf of the employer named above. The information on this form is true, complete, and accurate to the best of my knowledge. I understand it will be used to determine childcare subsidy eligibility and may be confirmed by program staff. * termsandconditions

5 Employer Representative Signature * Signature

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.