Work Verification Form

The work verification form is used by temporary or day workers. They are contracted to work on a single day. They are issued by a third party client who does so at the end of the contracted work day to the temporary or day worker. It has to be approved by the department in question and contains the name of the temporary worker. Work location, date and hours clocked on that particular day.

Sample Work Verification Form

Third Party Client’s name: David Engineering Corporation

2645 Illinois Street

Chicago, IL 87986

Last Name: ___________________ First Name: ________________________

Name of Day or Temporary Laborer: _______________________________________

Work Location: ___________________________________________

Destination Company Name: _______________________________________

Address Line 1: ____________________________________________

Address Line 2: _______________________________________________

City: ______________________________

State: _________________________________

Zip Code: _________________________________

Hours worked: _____________________________________

Signature of Company Representative: ________________Date: ____________

Download Work Verification Form in Word Format

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