Request for Employment Verification

TO: __________________________ Fax Number: ________________________

The person(s) named below has made application for rental housing with V. S. Rich Property Services. The Applicant has authorized you to release information about his/her employment to us. Your cooperation will be sincerely appreciated.

Applicant:

Name(s): _______________________________________________

Address: _______________________________________________

      ________________________________________________

Social Security Number: ______________________________

Applicant's Authorization of this inquiry

I hereby consent to the release of my employment information.

Applicant(s) Signature(s): _________________________ Date: ____________________

                                       __________________________ Date: ____________________

Employer's Information

Date of employment: From ___________ Is employment current? ____________________

Position ____________________________ Gross Salary per year __________________

Additional comment: ___________________________________________________

___________________________________________________________________

___________________________________________________________________

Signature: ____________________________ Title: ______________________

Date: _________________________________________