Date: [Date]
To (Organization/Agency): [Agency/Housing Authority/Court/School/Lender Name]
Attn: [Department/Contact Name]
[Address/Email (if known)]
From: [Your Full Name]
Address: [Street Address, City, State, ZIP]
Phone/Email (Optional): [Contact]
1. Unemployment Statement
1.1 I, [Your Full Name], confirm that I am currently unemployed.
1.2 Unemployment Start Date: [Date]
1.3 Reason for Unemployment (Optional): ☐ layoff ☐ termination ☐ contract ended ☐ reduction in hours ☐ medical leave ☐ other: [__]
2. Prior Employment (Optional)
2.1 Most Recent Employer: [Company Name]
2.2 Job Title (Optional): [Title]
2.3 Last Day Worked (Optional): [Date]
3. Unemployment Benefits (Optional)
3.1 Receiving Benefits (Select One):
☐ Yes — program/state agency: [__]
☐ No
☐ Application pending (date filed: [Date])
3.2 Benefits amount (optional): $[__] per [week/month] (if required).
4. Purpose of This Letter
4.1 I am providing this letter for: ☐ benefits ☐ housing ☐ court ☐ school ☐ lender ☐ other: [Purpose].
5. Supporting Documents (Optional)
5.1 Attached (if requested):
☐ unemployment claim status/award letter
☐ separation/termination notice (if available)
☐ prior pay stubs (optional)
☐ other: [List]
6. Truthful Statement
6.1 I declare that the statements in this letter are true and correct to the best of my knowledge.
Signatures
Name: [Your Full Name]
Date: [Date]
Signature: ___________________________
Employer Confirmation (Optional)
Employer/Contact Name: [Name]
Company: [Company]
Phone/Email: [__]
Statement: I confirm that [Your Full Name] is not currently employed with [Company] as of [Date].
Employer/Contact Signature: ___________________________
Date: [Date]
Notary / Notarization (Optional)
State of [State]
County of [County]
On [Date], before me, [Notary Name], personally appeared [Your Full Name] (and [Employer/Contact Name], if applicable), known to me (or satisfactorily proven) to be the person(s) whose name(s) are subscribed to this letter, and acknowledged that they executed it for the purposes stated.
Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________