Appendix 1
Employment Verification Template
From:
In the event of
query contact:
To:
Telephone:
Employment confirmation
Date
Thank you for taking the time to complete this form. We need some information about the person named below for
contract management purposes. Your employee has given us written permission for us to obtain this information. A
copy of this permission is available.
Employee Details
First
name
Last
Name
National Insurance No.:
Would you please complete sections 1 to 7 below as appropriate and the Certification
1 Company name (if different from above)
2 Employee’s job title
3 This is
a new job or a return to an existing job; – please complete parts 4, 5 and 7
an increase of more than 8 hours a week to an existing job; – please complete parts 4, 5, 6 and 7
an increase for an existing job to more than 16 hours a week; – please complete parts 4, 5, 6 and 7
4 Date the job started or returned to existing job or increase in hours occurred
5 On the date this job started/recommenced, or an increase in hours occurred, did you expect the job
to last at least 13 weeks? (Please tick appropriate box. This does not commit you to the employee)
Yes
No
6
If there has been a change in hours, What was the usual weekly number of hours previously
worked?
Hours
per wk
7 How many hours each week is the employee now working?
Hours
per wk
Certification
Your name
(please print)
Position
in company
Date
Signature
Telephone No.
Please impress your company or organisation stamp in
the box on the right, and return this form to the
address at the top using the prepaid envelope. If you
do not have a company stamp please attach a signed
compliments slip, business card or letterhead.
Thank you for your assistance.