Employer Affidavit of Employment Template

This Employer Affidavit of Employment (the “Affidavit”) is made on [Date] by:

Employer: [Company Legal Name]
Company Address: [Address]
Employer Phone/Email: [Contact]

Authorized Representative/Affiant: [Full Name], [Title/Department]
Work Address (If Different): [Address]
Phone/Email: [Contact]

Employee: [Employee Full Name]
Employee ID (Optional): [ID]
Employee DOB (Optional): [DOB]
Employee SSN/Tax ID (Last 4 Only) (Optional): [____]

1. Employment Verification

1.1 The employee listed above is employed by [Company Legal Name].
1.2 Job Title/Position: [Title]
1.3 Employment Status: ☐ Full-time ☐ Part-time ☐ Temporary ☐ Seasonal ☐ Contract (employee)
1.4 Start Date: [Date]
1.5 Current Employment (Select One): ☐ Active ☐ On leave (type: []) ☐ Terminated (date: [])
1.6 Work Location: ☐ On-site ☐ Remote ☐ Hybrid — Location/Office: [__]

2. Compensation (Optional — Include Only If Requested)

2.1 Pay Type: ☐ Hourly ☐ Salary ☐ Commission ☐ Mixed
2.2 Rate/Salary: $[Amount] per ☐ hour ☐ year (or base salary: $[])
2.3 Average Hours Per Week (If Hourly): []
2.4 Pay Frequency: ☐ Weekly ☐ Biweekly ☐ Semi-monthly ☐ Monthly
2.5 Additional Compensation (Optional): ☐ bonus ☐ commission ☐ tips ☐ other: []
2.6 Current Annualized Income (Optional): $[] (estimate).

3. Employment Details (Optional)

3.1 Supervisor Name/Title (Optional): []
3.2 Department (Optional): []
3.3 Good Standing (Optional): ☐ Yes ☐ No (if “No,” explain briefly): [__].

4. Purpose (Optional)

4.1 This Affidavit is provided for: ☐ loan/mortgage ☐ housing ☐ benefits ☐ court ☐ immigration ☐ other: [__].

5. Statement Under Oath

5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct based on the employer’s records and my knowledge as an authorized representative.

Signatures

Authorized Representative/Affiant: [Full Name]
Title: [Title]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Authorized Representative Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________