ࡱ> >A=g bjbjVV 8$r<r<[ %8J,v.X0!= "zMMM999MF9M99a,`qfvy}0,H# fH#H#MM9MMMMMoMMMMMMMH#MMMMMMMMM : Letter to Verify Employment The employer may submit a statement, on company letterhead, for verification. The statement must include: The name of the individual receiving the income The gross amount of income received The frequency of income received (i.e. weekly, every two weeks, twice a month, monthly or annually for seasonal or self-employed) A sample letter could be written as follows: This statement is to confirm that _______________________ is employed at Name of Employee _________________________. Name of Employer ______________________ received a gross income (before deductions for Name of Employee taxes, social security, insurance, etc.) of $______________ on ___/___/___. Date The frequency of payment is:  FORMCHECKBOX  Weekly  FORMCHECKBOX  Every two weeks  FORMCHECKBOX  Twice a month  FORMCHECKBOX  Monthly ________________________/_____________ __________________ Signature of Employer Title Date ___________________________________ (____)_________________ Address State Zip Code Telephone Number The U.S. Department of Agriculture prohibits discrimination against its customers, employees, and applicants for employment on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individuals income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.) If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at  HYPERLINK "http://www.ascr.usda.gov/complaint_filing_cust.html" http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at  HYPERLINK "mailto:program.intake@usda.gov" program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). USDA is an equal opportunity provider and employer.     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