Corporation Associates, Inc.

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Corporation Associates Employee Development Services

Employee Verification Form

Section One - Third-Party Information

Requestor's First Name:

Requestor's Last Name:

Requestor's Company Name:

Requestor's Phone Number:

Requestor's Email Address:

Requestor's Physical Address:

Section Two - Employee Information

Employee First Name:

Employee Last Name:

Last 4 of Employee SSN
or Employee ID:

Section Three - Legal Notice

The employee must provide his/her signature authorizing the release of their employment information before this request will be fulfilled. You must obtain the employee's signature either in writing or electronically on your company's form.

I have the employee's authorization for Corporation Associates, Inc. to release employment information as indicated above.

Section Four - Electronic Signature

I accept all terms and conditions in the above Legal Notice.

By entering in your name and date below, this constitutes an electronic signature.

Do not complete this form if you do not agree to use an electronic signature.

Requestor's Name: