Follow the steps to complete your Employment Certification Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Print the Family Child Care Provider Name in the designated area. Ensure the name is accurate for verification purposes.
3. Enter the birth date in the format of month/day/year. This information is crucial for the validity of the form.
4. Provide the Social Security Number in the specified format, as this is necessary for participation in the program.
5. Fill in the Facility Name and License Number (if applicable). This identifies the location where the provider is affiliated.
6. Input the mailing address of the provider. This ensures that any correspondence is directed to the correct location.
7. Specify the begin date of employment. Use the month/day/year format for clarity.
8. If applicable, enter the end date of employment. This should also be in the month/day/year format.
9. Print the provider's name clearly in the section provided before signing the document.
10. The provider must sign the form in the designated space to validate the information provided.
11. Provide a contact phone number to facilitate further communication if necessary.
12. Enter the date of signing the document in the appropriate format.
13. Attach copies of any relevant documents that verify the information claimed, such as State Fire Marshal reports or subsidy forms.
14. Review the completed form for accuracy and completeness before submitting.
15. Save your changes. You can also download, print, or share the form as required.

Complete your Employment Certification Form online today to ensure timely processing.