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Employment Verification Form I certify that SS --has worked at one site since //. CARES applicant Name Hire date Licensed Child Care Center staff Working directly with at least children under 5 years old. center. Has worked a minimum of 18 months at the child care center. Working a minimum of hours a week at Center Name and Address --OR Licensed Family Child Care Home Staff to be completed by Family Childcare Owner. The AB212 CARES participant to the best of my knowledge meets the Program requirements. Print Director/HR rep or Family Child Care Owner signature name Date Signature of Director/HR rep. or Family Child Care Owner Employer Telephone For Office Use Only Payment Status Date received Approved Pending Denied Coordinator Initials Incomplete Verified By Date Verified Unable to Verify NOTES AB212 CARES is administered by the YMCA Childcare Resource Service a department of the YMCA of San Diego County with funding from the California Department of Education through the County of San Diego. Employment Verification Form I certify that SS --has worked at one site since //. CARES applicant Name Hire date Licensed Child Care Center staff Working directly with at least children under 5 years old. center. Has worked a minimum of 18 months at the child care center. Working a minimum of hours a week at Center Name and Address --OR Licensed Family Child Care Home Staff to be completed by Family Childcare Owner. The AB212 CARES participant to the best of my knowledge meets the Program requirements. Print Director/HR rep or Family Child Care Owner signature name Date Signature of Director/HR rep* or Family Child Care Owner Employer Telephone For Office Use Only Payment Status Date received Approved Pending Denied Coordinator Initials Incomplete Verified By Date Verified Unable to Verify NOTES AB212 CARES is administered by the YMCA Childcare Resource Service a department of the YMCA of San Diego County with funding from the California Department of Education through the County of San Diego. Employment Verification Form I certify that SS --has worked at one site since //. CARES applicant Name Hire date Licensed Child Care Center staff Working directly with at least children under 5 years old. center. Has worked a minimum of 18 months at the child care center. Working a minimum of hours a week at Center Name and Address --OR Licensed Family Child Care Home Staff to be completed by Family Childcare Owner. center. Has worked a minimum of 18 months at the child care center. Working a minimum of hours a week at Center Name and Address --OR Licensed Family Child Care Home Staff to be completed by Family Childcare Owner. The AB212 CARES participant to the best of my knowledge meets the Program requirements. Print Director/HR rep or Family Child Care Owner signature name Date Signature of Director/HR rep* or Family Child Care Owner Employer Telephone For Office Use Only Payment Status Date received Approved Pending Denied Coordinator Initials Incomplete Verified By Date Verified Unable to Verify NOTES AB212 CARES is administered by the YMCA Childcare Resource Service a department of the YMCA of San Diego County with funding from the California Department of Education through the County of San Diego. .

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