The Texas Employment Verification form is a document used by employers to confirm the employment status and income of their employees or former employees. This form is essential for individuals applying for state benefits, as it provides necessary proof of employment and earnings. To ensure accurate processing, employers must complete and return the form promptly.
Need assistance? Fill out the form by clicking the button below.
The Texas Employment Verification form serves a critical function in the realm of employment and public assistance. This document is primarily utilized by employers to confirm the employment status and income of individuals who are applying for state benefits. It requires the employer to provide essential details such as the employee's name, Social Security number, and employment history, including the type of job held, rate of pay, and hours worked. The form also includes sections where employers must indicate whether the employee is full-time or part-time, as well as any additional compensation like tips or bonuses. Importantly, the employee must consent to the sharing of their information, allowing the employer to disclose relevant facts to the Texas Health and Human Services Commission (HHSC). Employers are instructed to complete the form accurately and return it through various means, including fax or mail, ensuring that the information is verified and submitted in a timely manner. This process not only aids in the assessment of eligibility for benefits but also helps employers understand their potential for tax credits related to hiring individuals receiving state assistance. By fostering this exchange of information, the Texas Employment Verification form plays a vital role in the intersection of employment and social services, ultimately supporting both the workforce and those in need of assistance.
Name and Address
Date
Need help? Call 2-1-1 or 877-541-7905.
Fax: 877-447-2839
Mail:
Texas Health and Human Services Commission
P O BOX 149027
Austin, Texas 78714-9027
If you are deaf, hard of hearing, or speech impaired, call 7-1-1 or 800-735-2989. All numbers are free to call.
Case Name
Case No.
This form is for your employer. They need to fill out the form and return it by. You must agree to let them give facts about you.
Fill Out and Sign This Agreement
I,
(print your name) allow HHSC to give my Social Security number (SSN) to the employer listed on this form.
My SSN can be used to get facts about my employment. I also allow the employer listed on this form to give facts asked on this form to HHSC.
Signature
Employer – Your Help Is Needed
Employee or Former Employee
Social Security No.
We need proof that the following person is or was your employee.
Some employers might get tax refunds or tax credits for hiring people who get certain state benefits.
To learn more, go to TexasWorkforce.org/wotc or email the Texas Workforce Commission at wotc@twc.state.tx.us.
Employer please follow these steps.
This person lives in a home in which someone is applying for state benefits. We need to know the amount of money this person makes or made from this job.
1.Please fill out the “Proof of Employment” form on the next page.
2.If a question doesn't apply, mark it with "N/A."
3.Return the form:
To send this back to us, you can either:
(a)give it to the employee listed above,
(b)mail it in the pre-paid envelope, or (c) fax it to 877-447-2839.
Form H1028 / 07-2022
Employment Verification
Form H1028
Page 2 / 07-2022-E
Proof of employment to be filled out by the employer.
Company or Employer
Address (Street, City, State, ZIP code)
Employee Name (as shown on your records)
Employee Address (Street, City, State, ZIP Code – as shown on your records)
Is (or was) this person employed by you?
If yes, what type of job?
Yes
No
Full Time
Part Time
Permanent
Temporary
If no: Stop here – sign and date the bottom of this form and return it.
If yes: Answer all the questions below. If a question doesn’t apply, write “N/A".
Rate of Pay
Per Day
Per Week
Per Month
Per Job
Per Hour
How Often Paid?
Average Hours Per Pay Period
Commissions Tips Bonuses
Overtime Pay
FICA or FIT Withheld
Profit Sharing or Pension Plan
Frequently
Rarely
Never
No If yes, current value?
Health insurance available?
If yes, employee is:
Name of Insurance Company
Not Enrolled
Enrolled with Family Member
Enrolled for Self Only
Date Hired
Date First Check Received
Average Hours Per Week
If Employee
is or was on Leave Without Pay:
Start Date:
End Date:
Do you expect any changes to the above information within the next few months? Yes No
If yes, explain:
On the chart below, list all wages received by this employee during the month(s) of:
Date Pay
Period Ended
Date Employee
Received Paycheck
Actual Hours
Gross
Pay
Other Pay*
(tips, commissions, bonuses)
EITC
Advance
Total Pretax
Contributions
*Please explain (in comments section below) when and how often tips, commissions, or bonuses are received. Comments
If this person is no longer in your employ.
Date Separated
Reason for Separation
Date Final Check Received
Gross Amount of Final Check
Employer – Read, Sign and Date
I confirm that this information is true and correct to the best of my knowledge:
Employer Signature
Title
Area Code and Phone No.
Completing the Texas Employment Verification form requires attention to detail to ensure all necessary information is accurately provided. After filling out the form, it must be returned to the Texas Health and Human Services Commission through one of the specified methods. Below are the steps to guide you through the process of filling out the form.
Once you have completed all sections of the form, ensure that it is signed and returned to the Texas Health and Human Services Commission by mail, fax, or given directly to the employee. This process will help facilitate the verification of employment as needed.
What is the Texas Employment Verification form?
The Texas Employment Verification form is a document used to confirm an individual's employment status. Employers fill out this form to provide information about their current or former employees, especially when those employees are applying for state benefits.
Who needs to fill out this form?
This form needs to be completed by the employer of the individual who is applying for state benefits. The employee must agree to allow their employer to share information about their employment.
What information does the employer need to provide?
The employer must provide details such as:
How should the employer return the completed form?
The employer can return the completed form in several ways:
What if a question on the form doesn't apply?
If a question does not apply to the employee, the employer should mark it as "N/A." This helps clarify that the question was considered but is not relevant.
What if the employee is no longer employed?
If the employee is no longer with the company, the employer should indicate the date of separation and the reason for leaving. This information is important for the verification process.
Is there a deadline for submitting the form?
What should the employee do after the form is completed?
Once the form is completed and returned, the employee should follow up with the relevant state agency to ensure their application for benefits is processed smoothly.
What if the employer has questions about the form?
If the employer has questions, they can call the Texas Health and Human Services Commission at 2-1-1 or 877-541-7905 for assistance. All calls are free.
What if the employee has a Social Security number?
The employee must agree to allow their Social Security number to be shared with the employer for verification purposes. This is necessary to obtain accurate employment information.
When filling out the Texas Employment Verification form, individuals often make several common mistakes that can lead to delays or complications. One significant error is failing to provide complete and accurate personal information. This includes not only the employee's name but also their Social Security number. Omitting or miswriting this information can hinder the verification process, as the employer needs precise details to confirm employment.
Another frequent mistake is neglecting to sign the agreement section. The form requires the employee's signature to authorize the release of their information. Without this signature, the employer cannot legally provide the necessary employment details. This oversight can result in the form being rejected or returned, causing unnecessary delays.
In addition, some individuals mistakenly leave questions unanswered or mark them incorrectly. For example, if a question does not apply, it should be marked with "N/A." Failing to do so may confuse the employer or lead to incomplete information being submitted. Each question is designed to gather specific details about employment, and clarity is essential for accurate processing.
People also sometimes overlook the importance of providing the correct employer information. This includes the employer's name and address, which must match the records held by the Texas Health and Human Services Commission. Inaccurate details can create discrepancies that complicate the verification process.
Finally, individuals may forget to check for updates or changes in their employment status before submitting the form. If there are any anticipated changes, such as a shift from part-time to full-time work, this information should be communicated clearly. Providing up-to-date information is crucial for ensuring that the verification accurately reflects the employee's current situation.
The Texas Employment Verification form is an essential document for employers to confirm an employee's work status and income. However, several other forms and documents often accompany it to provide a complete picture of an individual's employment situation. Below is a list of these related documents, each serving a specific purpose in the verification process.
Collectively, these documents help create a thorough understanding of an individual's employment status and financial situation. Each form plays a vital role in ensuring accuracy and compliance in employment verification processes.
The Texas Employment Verification form shares similarities with several other employment-related documents. Below is a list of these documents and how they relate to the Texas Employment Verification form.
When filling out the Texas Employment Verification form, it is important to follow certain guidelines to ensure accuracy and compliance. Below are six things you should and shouldn't do.
Following these guidelines will help ensure that the employment verification process runs smoothly and efficiently.
Misconceptions about the Texas Employment Verification form can lead to confusion for both employees and employers. Here are ten common misunderstandings:
Understanding these misconceptions can help streamline the employment verification process and ensure that both employees and employers fulfill their responsibilities efficiently.
Here are some key takeaways about filling out and using the Texas Employment Verification form: