Get Verification Of Employment - New York State Department Of Health

Filling out the Verification of Employment form is a crucial step in confirming an individual's employment status for health insurance purposes. This guide provides a clear and straightforward method to complete the form online, ensuring that all necessary information is accurately captured.

Follow the steps to complete the Verification of Employment form online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the individual's name in the designated blank, followed by their application or case number.
3. Fill in the social security number of the individual in the appropriate field.
4. Provide the current address of the individual, ensuring to include city, state, and zip code.
5. In the section labeled 'To be completed by the employer', type the employee's name and their job title or position.
6. Indicate the payment frequency by circling one of the options: week, two weeks, or twice per month.
7. Answer whether the employee has access to New York State Health Insurance by selecting 'Yes' or 'No'.
8. Next, confirm if the employee has dependents enrolled in their employer-sponsored health coverage by selecting 'Yes' or 'No'.
9. Fill in the last four consecutive weeks the employee was paid, along with the corresponding dates and gross pay, which should include any tips, commissions, or bonuses.
10. If the individual is no longer employed, indicate the last working date in the provided field.
11. Enter the name and address of the business where the individual was employed, including city, state, and zip code.
12. Provide the business telephone number for the employer.
13. Finally, the employer must print their name, title, sign the form, and date it.
14. Once all sections are completed, you can save the changes, and choose to download, print, or share the form as needed.

Complete the Verification of Employment form online today to ensure a smooth verification process.