Contact Us 864.366.4549

Employment Verification

508 Haigler Street Abbeville, SC 29620
Monday - Thursday: 7:30 a.m. EST - 4:30 p.m. EST
Friday: 7:30 a.m. EST - Noon
Tel: 864.366.4549
Fax: 864.366.4341
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[{"type":"text","label":"To: Employer Name","name":"To-Employer-Name","className":"col-md-6","subtype":"text"},{"type":"date","label":"Today's Date","name":"Todays-Date","className":"col-md-6"},{"type":"text","label":"Employer Street Address","name":"Employer-Street-Address","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer City","name":"Employer-City","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"select","label":"Employer State","name":"Employer-State","className":"col-md-6 col-lg-3","values":[{"label":"Alabama","value":"AL"},{"label":"Alaska","value":"AK"},{"label":"Arizona","value":"AZ"},{"label":"Arkansas","value":"AR"},{"label":"California","value":"CA"},{"label":"Colorado","value":"CO"},{"label":"Connecticut","value":"CT"},{"label":"Delaware","value":"DE"},{"label":"District of Columbia","value":"DC"},{"label":"Florida","value":"FL"},{"label":"Georgia","value":"GA"},{"label":"Hawaii","value":"HI"},{"label":"Idaho","value":"ID"},{"label":"Illinois","value":"IL"},{"label":"Indiana","value":"IN"},{"label":"Iowa","value":"IA"},{"label":"Kansas","value":"KS"},{"label":"Kentucky","value":"KY"},{"label":"Louisiana","value":"LA"},{"label":"Maine","value":"ME"},{"label":"Maryland","value":"MD"},{"label":"Massachusetts","value":"MA"},{"label":"Michigan","value":"MI"},{"label":"Minnesota","value":"MN"},{"label":"Mississippi","value":"MS"},{"label":"Missouri","value":"MO"},{"label":"Montana","value":"MT"},{"label":"Nebraska","value":"NE"},{"label":"Nevada","value":"NV"},{"label":"New Hampshire","value":"NH"},{"label":"New Jersey","value":"NJ"},{"label":"New Mexico","value":"NM"},{"label":"New York","value":"NY"},{"label":"North Carolina","value":"NC"},{"label":"North Dakota","value":"ND"},{"label":"Ohio","value":"OH"},{"label":"Oklahoma","value":"OK"},{"label":"Oregon","value":"OR"},{"label":"Pennsylvania","value":"PA"},{"label":"Rhode Island","value":"RI"},{"label":"South Carolina","value":"SC","selected":true},{"label":"South Dakota","value":"SD"},{"label":"Tennessee","value":"TN"},{"label":"Texas","value":"TX"},{"label":"Utah","value":"UT"},{"label":"Vermont","value":"VT"},{"label":"Virginia","value":"VA"},{"label":"Washington","value":"WA"},{"label":"West Virginia","value":"WV"},{"label":"Wisconsin","value":"WI"},{"label":"Wyoming","value":"WY"}]},{"type":"text","label":"Employer Zip Code","name":"Employer-Zip-Code","className":"col-md-6 col-lg-3","subtype":"text"},{"type":"text","label":"Employer Fax Number","name":"Employer-Fax-Number","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"email","label":"Employer Email","name":"Employer-Email","className":"col-lg-4"},{"type":"text","subtype":"email","required":true,"label":"Employer Email Confirmation","name":"Employer-Email-Confirmation","className":"col-lg-4"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Resident/Applicant First Name<br>","name":"ResidentApplicant-First-Name","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Resident/Applicant Last Name","name":"ResidentApplicant-Last-Name","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Resident/Applicant Social Security Number","name":"ResidentApplicant-Social-Security-Number","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"To Whom It May Concern,<br>The person named above is a resident/applicant for the housing assistance under a program of the Department of Housing and Urban Development (HUD). We are required to verify all information that is used to determine this person's eligibility and/or level of benefits. In order the complete this process we ask your cooperation in providing the information requested below and returning it to us via facsimile or in the enclosed self-addressed, stamped envelope. Thank you for your prompt attention to this matter. If you have any questions, please contact us at 864.366.4549.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<b>RELEASE: </b><br>I hereby authorize the release of the requested information. This consent for the release of information shall be valid for up to 15 months of the date of my signature.","className":"d-block"},{"type":"text","label":"Resident/Applicant Signature","placeholder":"Disclaimer: By typing your name, you are signing this document.","name":"ResidentApplicant-Signature","className":"col-md-6","subtype":"text"},{"type":"date","label":"Date of Resident/Applicant Signature","name":"Date-of-ResidentApplicant-Signature","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<b>Information Requested: </b>Verification of amount and type of household income.","className":"d-block"},{"type":"checkbox-group","label":"1. Is person named above currently employed by your firm?","inline":true,"name":"1-Is-person-named-above-currently-employed-by-your-firm","className":"d-block","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"date","label":"2. Date Employment Began","name":"2-Date-Employment-Began","className":"col-md-6"},{"type":"text","label":"3. Position Held","name":"3-Position-Held","className":"col-md-6","subtype":"text"},{"type":"text","label":"4. Current Rate of Pay per Hour","name":"4-Current-Rate-of-Pay-per-Hour","className":"col-md-6","subtype":"text"},{"type":"date","label":"5. Effective Date of Current Rate of Pay","name":"5-Effective-Date-of-Current-Rate-of-Pay","className":"col-md-6"},{"type":"text","label":"6. Regularly scheduled hours per week","name":"6-Regularly-scheduled-hours-per-week","className":"col-md-6","subtype":"text"},{"type":"text","label":"7. Average overtime hours per week","name":"7-Average-overtime-hours-per-week","className":"col-md-6","subtype":"text"},{"type":"text","label":"8. Increase (If applicable)","name":"Increase-If-applicable","className":"col-md-6","subtype":"text"},{"type":"text","label":"9. Amount of bonuses, commissions, tips, etc. ","name":"Amount-of-bonuses-commissions-tips-etc","className":"col-md-6","subtype":"text"},{"type":"date","label":"10. Next <b>anticipated</b> rate increase (if applicable)","name":"Date-of-next-anticipated-rate-increase-if-applicable","className":"col-md-6"},{"type":"text","label":"11. Amount of <b>projected </b>rate increase","name":"11-Amount-of-projected-rate-increase","className":"col-md-6","subtype":"text"},{"type":"checkbox-group","label":"12. Is any portion of income derived from Title V Older American Community Services Program?","inline":true,"name":"12-Is-any-portion-of-income-derived-from-Title-V-Older-American-Community-Services-Program","className":"col-md-6","values":[{"label":" Yes ","value":"Yes"},{"label":" No","value":"No"}]},{"type":"checkbox-group","label":"13. Is employment associated with any other community-training program, which has referred the employee to your site for training purposes? ","inline":true,"name":"13-Is-employment-associated-with-any-other-community-training-program-which-has-referred-the-employee-to-your-site-for-training-purposes","className":"col-md-6","values":[{"label":" Yes","value":"Yes"},{"label":"No","value":"No"}]},{"type":"text","label":"14. Does income include Earned Income Tax Credit Refund Advance?","name":"14-Does-income-include-Earned-Income-Tax-Credit-Refund-Advance","className":"col-md-6","subtype":"text"},{"type":"text","label":"If income include Earned Income Tax Credit Refund Advance, provide amount.","name":"If-income-include-Earned-Income-Tax-Credit-Refund-Advance-provide-amount","className":"col-md-6","subtype":"text"},{"type":"text","label":"15. Amount deducted from gross income for Medicare Insurance Premiums (If applicable)","name":"15-Amount-deducted-from-gross-income-for-Medicare-Insurance-Premiums-If-applicable","className":"col-md-6","subtype":"text"},{"type":"text","label":"16. Anticipation duration of present situation","name":"16-Anticipation-duration-of-present-situation","className":"col-md-6","subtype":"text"},{"type":"date","label":"17. <b>If not currently employed</b>, what date did employment stop?","name":"17-If-not-currently-employed-what-date-did-employment-stop","className":"col-md-6"},{"type":"text","label":"18. Was employee terminated or did he/she quit their job?","name":"18-Was-employee-terminated-or-did-heshe-quit-their-job","className":"col-md-6","subtype":"text"},{"type":"text","label":"19. Is former employee eligible for Unemployment Benefits and/or Severance Pay?","name":"Is-former-employee-eligible-for-Unemployment-Benefits-andor-Severance-Pay","className":"col-md-6","subtype":"text"},{"type":"text","label":"20. If former employee is eligible, what is the amount?","name":"If-former-employee-is-eligible-what-is-the-amount","className":"col-md-6","subtype":"text"},{"type":"text","label":"21. Other","name":"21-Other","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"text","label":"Signature of Person Supplying Information","placeholder":"Disclaimer: By typing your name, you are signing this document.","name":"Signature-of-Person-Supplying-Information","className":"col-md-6","subtype":"text"},{"type":"text","label":"Firm or Organization Name","name":"Firm-or-Organization-Name","className":"col-md-6","subtype":"text"},{"type":"text","label":"Title of Person Signing","name":"Title-of-Person-Signing","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Telephone Number of Person Signing","name":"Telephone-Number-of-Person-Signing","className":"col-lg-4","subtype":"text"},{"type":"date","label":"Date of Signature","name":"Date-of-Signature","className":"col-lg-4"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<b>PENALTIES FOR MISUSING THIS CONSENT: </b>TITLE 18, SECTION 1001 OF THE U.S.  Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD,  the PHA and any Owner (or employee of HUD, the PHA or the Owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person, who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, the PHA or the Owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number is contained in the Social Security Act at 42 U.S.C (208) (a) (6), (7) and (8). Violation of these provisions are cited as violations of 42 U.S.C. (408) (a) (6), (7) and (8).","className":"d-block"}]