Free Texas Employment Verification PDF Form Prepare Document Here

Free Texas Employment Verification PDF Form

The Texas Employment Verification Form, known informally as Form H1028, serves as a critical tool for the Texas Health and Human Services Commission (HHSC) to confirm the employment details of individuals applying for state benefits. This comprehensive form, which must be filled out by employers, plays a key role in determining eligibility for various programs by verifying employment status, income, and other pertinent information. If you're navigating the process of applying for state benefits or are an employer required to complete this verification, consider clicking the button below to ensure you fill out the form correctly and expediently.

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Content Overview

The Texas Employment Verification Form, pivotal for both employers and employees within the state, serves as a structured means to confirm an individual's employment status and income details. Required in situations where individuals or families apply for state benefits, this form plays a critical role in the benefits application process by verifying an employee's financial eligibility. Through this document, employers are asked to furnish comprehensive details about the employment status, type of job, payment specifics including rate and frequency, benefits like health insurance, and any expected changes to the employment situation. Notably, it emphasizes the importance of accuracy and honesty by necessitating an employer's signature to affirm that the information provided is true and correct. Furthermore, the form accommodates for those with disabilities by providing contact numbers for assistance and also highlights potential tax advantages for employers through certain hires. In essence, this form facilitates a smoother interaction between the state's health and human services and the workforce, ensuring that aid reaches those who are truly in need based on verified employment information.

Example - Texas Employment Verification Form

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

Date

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

Yes

No

Frequently

Rarely

Never

Yes

No

Yes

No If yes, current value?

Health insurance available?

If yes, employee is:

 

 

 

Name of Insurance Company

Yes

No

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

 

Date

Title

Area Code and Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

Form Data

Fact Name Description
Purpose of the Form This form is intended to verify employment information for individuals applying for state benefits in Texas.
Contact Information Provided Provides various contact methods, including phone numbers for general inquiries, fax, and mailing address for the Texas Health and Human Services Commission.
Accessibility Options Includes specific contact numbers for individuals who are deaf, hard of hearing, or speech impaired.
Employer Incentives Mentions potential tax refunds or credits for employers who hire individuals receiving certain state benefits, directing them to the Texas Workforce Commission for more information.
Instructions for Employers Guides employers on how to complete the form, including how to address questions that do not apply and how to return the completed form.
Employment Details Required Asks for detailed employment information including employment status, rate of pay, benefits, hours worked, and additional income like bonuses or commissions.

How to Fill Out Texas Employment Verification

Filling out the Texas Employment Verification form takes a bit of attention to detail but is straightforward if you follow the steps below. This process is designed to verify employment information critical for state benefits eligibility. Both the employee and employer play vital roles in completing and submitting this form accurately and timely. Let's break down the steps needed for both parties to ensure the form is filled out properly.

For the Employee:
  1. Complete the top section by entering your Case Name and Case No., if applicable.
  2. In the "Fill Out and Sign This Agreement" section, print your name clearly.
  3. Provide your Social Security Number (SSN) in the space given. This is crucial for the verification process.
  4. Sign and date the form to give consent for the Texas Health and Human Services Commission (HHSC) and your employer to share your employment details.
For the Employer:
  1. Start with the "Proof of Employment" section on the second page of the form.
  2. Enter your Company or Employer Address and Employee Name as shown on your records.
  3. Indicate whether the person is or was employed by you by ticking the appropriate option. If "No", sign at the bottom and return the form.
  4. If "Yes", fill in the type of job and proceed to answer all the following questions.
  5. For each question, provide accurate information regarding the employee's rate of pay, hours worked, benefits, and any other compensation received.
  6. If a particular question does not apply, please mark it with "N/A".
  7. List all wages received by the employee for the specified month(s), including tips, commissions, bonuses, and other pay details in the provided chart.
  8. Include any pertinent comments about the employee’s pay structure or expected changes.
  9. Complete the section about the employee's separation, if applicable, including the date separated, reason for separation, and details of the final check received.
  10. Read the declaration at the end of the form, then sign and date it, confirming the accuracy of the information provided. Include your title, area code, and phone number.
  11. Return the form by giving it to the employee, mailing it using the pre-paid envelope, or faxing it to 877-447-2839.

Once completed, ensuring the form's accuracy and prompt submission will facilitate the necessary verification process for state benefits eligibility. Employers are encouraged to provide comprehensive details to support their employee's application, and employees should double-check the form for completeness before and after the employer fills it out.

FAQ

What is the Texas Employment Verification form?

The Texas Employment Verification form, also known as Form H1028, is a document used by the Texas Health and Human Services Commission (HHSC) to verify employment information for individuals applying for or receiving state benefits. Employers are requested to provide details about an employee or former employee's job status, wages, and other relevant information.

Why do employers need to fill out this form?

Employers are asked to fill out this form as part of the process to verify employment and income information for individuals applying for state assistance. This verification helps ensure that applicants are eligible for the benefits they are applying for. Additionally, some employers may be eligible for tax refunds or credits for hiring individuals who receive certain state benefits.

How can employers send the completed form back to HHSC?

Once an employer has completed the form, it can be returned to the Texas Health and Human Services Commission via three methods: giving it to the employee to submit, mailing it in the pre-paid envelope provided, or faxing it to the number 877-447-2839.

What should employers do if they cannot answer a question on the form?

If an employer encounters a question on the verification form that does not apply to their situation or the employee in question, they should mark it with "N/A" (not applicable). This indicates that the question does not have a relevant answer in their specific case.

Is there help available for those who have questions while filling out this form?

Yes, assistance is available for individuals or employers who have questions or need help when completing the Employment Verification form. They can call 2-1-1 or 877-541-7905. Additionally, deaf, hard of hearing, or speech-impaired individuals can call 7-1-1 or 800-735-2989 for assistance. All these numbers are free to call.

What information about the employee do employers need to provide?

Employers are required to provide detailed information about the employment status of the individual, including whether they are currently employed or if they were a past employee, the type of job, rate of pay, hours worked per pay period, and other compensations like commissions, bonuses, or overtime pay. Information regarding health insurance, pension plans, and if applicable, the reason for and date of separation, are also requested on the form.

Can employers receive benefits for providing this information?

Employers may be eligible for tax refunds or credits through programs like the Work Opportunity Tax Credit (WOTC) for hiring individuals who receive certain types of state benefits. To learn more about eligibility and how to claim these benefits, employers can visit TexasWorkforce.org/wotc or email the Texas Workforce Commission at wotc@twc.state.tx.us.

Common mistakes

When completing the Texas Employment Verification form, it's important to be meticulous to avoid common pitfalls. Here are six mistakes often made:

  1. Not printing the employee's name clearly and accurately at the beginning of the agreement section. This mistake can lead to confusion about whom the employment information pertains to.
  2. Failing to mark questions that don't apply with "N/A" can leave parts of the form looking incomplete. This oversight might suggest that the question was missed rather than being intentionally skipped.
  3. Inaccurately reporting the rate of pay or not specifying the correct payment frequency (e.g., per hour, per week) can lead to misunderstandings about the employee's compensation.
  4. Omitting details about other forms of pay such as commissions, tips, and bonuses, or not explaining their frequency and conditions, can paint an incomplete picture of the employee’s total earnings.
  5. Forgetting to sign and date the bottom of the form by the employer can invalidate the verification, as an unsigned form may not be recognized as official or completed.
  6. Not indicating whether health insurance is available to the employee and, if so, failing to specify the enrollment status, overlooks an important element of the employment package.

By avoiding these common errors, the form can be filled out more accurately and effectively, ensuring the intended purpose is served without unnecessary delays.

Documents used along the form

When completing employment verification in Texas, several other forms and documents are commonly used in conjunction with the Texas Employment Verification form to ensure a comprehensive verification process. These forms and documents not only facilitate a smoother verification process but also ensure compliance with employment and legal standards. Below are five key documents often utilized.

  • W-4 Form: This is an IRS document used by employers to determine the correct amount of tax withholding to deduct from employees' wages. It is essential for new hires and can be updated when the employee's personal or financial situation changes.
  • I-9 Form: The Employment Eligibility Verification Form is a U.S. Citizenship and Immigration Services form. It is used by an employer to verify an employee's identity and to establish that the worker is eligible to accept employment in the United States.
  • Direct Deposit Authorization Form: This form is used by employees to authorize direct deposit of their paychecks into their bank accounts. It typically requires the employee's bank account and routing numbers.
  • State-specific New Hire Reporting Form: Employers are required to report new hires to the state as part of the effort to enforce child support obligations. In Texas, employers must provide this information to the Texas New Hire Reporting Center.
  • Employee Handbook Acknowledgment Receipt: This document is an acknowledgment by the employee that they have received, read, and understood the company's employee handbook. It often outlines important policies, procedures, and company culture.

Together, these documents play a vital role in the onboarding process, ensuring that both employer and employee obligations are met. From tax withholding to employment eligibility, and from direct deposit setups to compliance with state-specific requirements, these forms form the foundation of a legally sound employment relationship in Texas.

Similar forms

The Texas Employment Verification form is a vital document for establishing employment status and earnings verifiable by an employer. There are several other documents that share similarities in purpose or content with the Texas Employment Verification form:

  • Form I-9, Employment Eligibility Verification: Similar to the Texas Employment Verification form, this federal document verifies an employee's legal right to work in the United States. Both forms require employer validation and include personal information of the employee.
  • W-2 Form, Wage and Tax Statement: The W-2 form, needed for tax filing purposes, also provides detailed information on an employee's earnings, much like the Texas form, including details on wages and tax withholdings.
  • Form W-4, Employee's Withholding Certificate: Although the W-4 form is used by employees to determine tax withholdings, it shares the concept of employment and income facts with the Texas Employment Verification form, especially in its use for financial assessments.
  • Pay Stubs: Pay stubs offer detailed information about an employee's earnings, deductions, and net pay over a payment period. They are similar to the Texas form's section where employers list wages, tips, and other compensations.
  • Unemployment Benefits Application: This application requires proof of employment and earnings, closely mirroring the purpose of the Texas Employment Verification form in verifying employment facts.
  • Loan Application Forms: Many loan applications require proof of employment and income, for which the Texas Employment Verification form can provide validated information directly from the employer, making the processes similar in their need for employment verification.
  • Background Check Authorization Forms: These forms, which may include verification of employment history as part of a broader background check, have a similar need for accurate employment data as provided by the Texas form.
  • Rental Application Forms: Like loan applications, rental applications often require proof of employment and income, making the Texas Employment Verification form an important document for confirming these details.
  • Proof of Employment Letters: Customarily written by employers, these letters serve a similar purpose by stating an individual’s employment status, role, and sometimes earnings, akin to the verification provided by the Texas form.
  • Employee Benefit Application Forms: These forms might require information about an employee’s status and earnings to determine eligibility for benefits, paralleling the Texas form's role in providing verifiable employment data.

Each of these documents, while serving distinct functions, shares the core feature of validating employment status, income, or both, directly contributing to financial, legal, or regulatory processes.

Dos and Don'ts

When completing the Texas Employment Verification form, it's vital to pay close attention to the accuracy and completeness of the information. Here are some guidelines that will help ensure the process is done correctly and efficiently:

  • Do:
    1. Read the form thoroughly before starting to fill it out. Understanding what is required can help prevent errors and omissions.
    2. Ensure the employer's information is accurate and up-to-date, including the company address and contact information.
    3. Use N/A for questions that do not apply to your situation to demonstrate that you have reviewed each question.
    4. Double-check the Social Security number provided to avoid any mismatch or processing delays.
    5. Ensure that all dates are correctly entered, including employment start and end dates, if applicable.
    6. Provide detailed job information, including employment type (Full Time, Part Time, Permanent, Temporary), which helps in understanding the employment situation better.
    7. Before submitting, review the form for completeness and accuracy. Missing or inaccurate information can lead to unnecessary delays.
  • Don't:
    1. Avoid rushing through the form without paying attention to the instructions, as this might lead to errors.
    2. Do not leave relevant fields blank; instead, use "N/A" when a question is not applicable.
    3. Do not forget to sign and date the form, as an unsigned form may be considered invalid.
    4. Avoid guessing information about the employment details. If uncertain, verify the information before completing the form.
    5. Do not omit the reason for separation if the employee is no longer employed, as this information is crucial.
    6. Do not neglect to list all wages received, including tips, commissions, and bonuses, for a comprehensive earnings view.
    7. Avoid specifying personal opinions or observations about the employee's performance, as the form is strictly for verification purposes.

Completing the Texas Employment Verification form correctly and thoughtfully not only aids in the prompt processing of applications but also supports individuals and families in accessing necessary state benefits. Taking the time to ensure all information is accurate and complete reflects well on the employer and assists employees in their endeavors.

Misconceptions

There are several misconceptions about the Texas Employment Verification form that need clarification. Below is a list highlighting and explaining some of the most common misunderstandings.

  • The form is only for current employees. This is not accurate. The form is designed for both current and former employees. It asks for employment verification information that can apply to someone who has left the company as well.
  • Employers are not required to complete the form. While completion of the form might seem optional, when it is requested for state benefits or tax credits, employers are encouraged to fill it out. It assists employees in accessing state benefits and employers in qualifying for possible tax credits.
  • The form is complicated to fill out. The form is straightforward. It provides clear instructions on what is needed from the employer, including marking non-applicable sections with "N/A."
  • It's only about wages. Besides information on wages, the form requests details on employment type, benefits, and any expected changes, making it a comprehensive employment verification tool.
  • Small businesses are exempt from filling out this form. This misconception is false. The form does not specify any exemptions based on business size; thus, any employer might be required to fill it out.
  • Employers need the employee’s consent to fill out the form. The form itself includes an agreement section where the employee consents for the employer to provide the requested information, thereby making the process compliant with privacy concerns.
  • The information provided won't affect the employee's state benefits. Properly filled forms can impact state benefits, as they provide essential verification of employment and income.
  • Electronic submissions are not acceptable. The form clearly provides a fax number, indicating that electronic submission via fax is permitted and provides an alternative to mailing the document.
  • There's no support available for completing the form. The form lists contact numbers and a mailing address for assistance, offering resources for anyone needing help.
  • Only wages need to be detailed. The form requires information beyond just wages, including job type, benefits, and payroll deductions, giving a full picture of an employee's compensation.

Addressing these misconceptions ensures both employers and employees handle the Texas Employment Verification form correctly, facilitating smoother process for verifying employment for state benefits or tax credits.

Key takeaways

Filling out and using the Texas Employment Verification Form is a straightforward process, yet it's vital for ensuring that both employees and employers adhere to state requirements. Here are key takeaways to keep in mind:

  • The Texas Employment Verification Form is primarily used to verify employment status and income for individuals applying for state benefits.
  • Before the form can be used, the employee must sign an agreement allowing their employer to disclose their employment information to the Texas Health and Human Services Commission (HHSC).
  • It's important for the employee's Social Security Number (SSN) to be provided for the purpose of obtaining employment facts.
  • Employers are encouraged to fill out the Proof of Employment section comprehensively, indicating the employee's job status, pay rate, and other compensation details.
  • If certain questions on the form do not apply, employers should mark them with "N/A" instead of leaving them blank.
  • Once completed, the form can be returned to the HHSC via mail, fax, or given directly to the employee to submit.
  • Employers should be aware that providing employment verification can potentially qualify them for tax refunds or credits, particularly if they hire individuals receiving certain state benefits.
  • For any questions or assistance with the form, employers and employees can contact the provided numbers for support or visit the Texas Workforce Commission website.

In conclusion, the Texas Employment Verification Form plays a crucial role in the administration of state benefits, making it essential for both employees and employers to understand and properly complete the form. Ensuring accuracy and completeness can help streamline the process for all parties involved.

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