Georgia Employment Verification Template
This document is prepared to assist in the verification of employment within the state of Georgia, ensuring compliance with relevant state-specific regulations such as the Georgia State Employment Privacy Law. Please fill in the necessary details where blanks are provided to accurately complete the employment verification process.
Section 1: Employer Information
- Company Name: ________________________
- Company Address: ________________________
- City: ____________, State: Georgia, Zip Code: _________
- Company Phone Number: (____)_____________
- Company Email Address: ________________________
Section 2: Employee Information
- Employee Name: ________________________
- Employee Job Title: ________________________
- Employee Department: ________________________
- Employee Start Date: ________________________
- Current Employment Status: Full-Time / Part-Time / Contract / Other: _________
Section 3: Employment Verification Requester Information
- Requester Name: ________________________
- Company/Organization: ________________________
- Address: ________________________
- City: ____________, State: ________, Zip Code: _________
- Phone Number: (____)_____________
- Email: ________________________
- Relationship to the Employee: ________________________
- Purpose of the Verification: ________________________
Section 4: Verification Details
- Employment Start Date
- Employment End Date (if applicable)
- Position(s) Held
- Salary Information (note: Georgia law may require employee consent to release this information)
- Reason for Termination (if applicable)
Section 5: Consent
I, ________________________ (employee name), hereby grant permission to _________________ (employer name) to release the information requested above. I understand this verification is being provided for the purpose of _____________ as stated by the requester, and any information provided will be used in a manner consistent with Georgia state laws.
_________________________________
Employee Signature
_________________________________
Date
Section 6: Employer Verification
This section to be completed by the employer or authorized representative.
I, ________________________, certify that the above information is accurate to the best of my knowledge and belief, and is provided in response to the verification request received.
_________________________________
Signature of Authorized Representative
_________________________________
Title
_________________________________
Date
Please note that forgery of a signature or falsification of information within this document may lead to legal consequences under Georgia law.