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.Syw' <br /> VERIFICATION OR Employment — Co-Applicant Name of Employer: <br /> (Applicant Information) Employed Since occupation <br /> Pay rate: Date of Next Increase <br /> Name of Applicant or Tenant: <br /> Pay Frequency (Hr, Wk , Mo) : <br /> Average Hours per Week at Base Pay Rate: <br /> Social Security Number: Hours Weeks or Months <br /> worked per year. <br /> Return to : Average number of overtime hours expected during the next <br /> 12 months Overtime Pay Rate: Per Hour . <br /> NSP Program Coordinator <br /> Indian River Habitat for Humanity Total Base Pay expected for the next 12 months$ <br /> 456 $ N . US Highway 1 Any other compensation not included above (specify for <br /> Vero Beach , FL 32967 commissions, bonuses, tips, etc.) <br /> Fax : 772 FOR $ PerNow <br /> Vacation Pay (Y or N) If yes, Number of days per year <br /> Total Base Pay Earnings for past 12 months $ <br /> Your prompt return of the requested information will Total Overtime Earnings for past 12 months $ <br /> be appreciated . A self-addressed return envelope Is Probability & Expected Date of Any Pay Increase : <br /> enclosed . <br /> Does the employee have access to a Retirement Account? <br /> ❑ Yes ❑ No <br /> If yes , what amount can they get access to? $ <br /> * Employers - Please complete this sect <br /> RELEASE : I hereby authorize the release of Signature of or <br /> the requested information . <br /> X Authorized Representative <br /> (Signature of Applicant/Tenant) <br /> Date : Agency Name : <br /> or ; Title : <br /> A copy of the executed " Release of Information <br /> Form " is attached which authorizes the release Date : <br /> of information requested . <br /> Telephone . <br /> WARNING : Florida Statute 817 provides that willful false statements or misrepresentation concerning income and assets or liabilities <br /> relating to financial condition is a misdemeanor of the first degree and is punishable by fines and imprisonment provided under S 775.082 <br /> or 775 . 83 . <br />