Georgia Employment Verification Form
This Employment Verification Form is designed specifically for use within the state of Georgia. It serves to confirm the employment status of the individual named below, in accordance with the Georgia Fair Employment Practices Act.
Employee Information:
- Employee Name: __________________________
- Employee Address: ________________________
- City, State, Zip Code: ____________________
- Employee Phone Number: ___________________
- Employee Job Title: _______________________
- Department: _______________________________
- Employment Start Date: ____________________
- Employment End Date (if applicable): ___________
Employer Information:
- Company Name: ___________________________
- Company Address: ________________________
- City, State, Zip Code: ____________________
- Employer Phone Number: ___________________
- Authorized Representative Name: _____________
- Authorized Representative Title: ______________
The information provided will be used solely for verification purposes. Please complete the form and return it to the requester.
By signing below, I hereby certify that the information provided is accurate and true to the best of my knowledge.
Authorized Signature: __________________________
Date: ________________________________________