Employment Verification Request Form

University of Wisconsin Office of Human Resources

Employment Verification Request

Requestor Name	Request Date (mm/dd/yyyy)
Requestor Email Address	Requestor Phone
Requestor Company Name	Requestor Title

Employee Name (Last, First, Middle Initial)

Employee Date of Birth (mm/dd/yyyy)

By completing and sending this on-line form you will receive the employment start and termination dates, and position title.

If you require additional information, you can complete this form, print it and attach an Authorization for Release of Information form signed by the employee. (The Authorization for Release of Information form is provided by a financial institution, lawyer, employer, credit bureau, etc. to the employee.) Fax all forms to (608) 890-2414.

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