Dshs form 14 252 2026

1. Click ‘Get Form’ to open the DSHS Form 14 252 in the editor.
2. Begin with Section 1, where the client/employee must authorize their employer to release information. Fill in your name, sign, and optionally provide your Social Security Number and date.
3. Move to Section 2, which is for the employer. Enter the employee’s name, job title, and employer’s address. Specify the start date of employment and indicate if this is a new job.
4. Complete details regarding average hours worked per week, pay frequency, and rate of pay or salary. If applicable, answer questions about work study status and job end dates.
5. Provide actual gross income for the last three months as well as anticipated income for the current month and next two months. Include any tips, commissions, bonuses, or overtime details.
6. Fill in the work schedule for each day of the week and indicate if health insurance is available. If yes, provide additional details about enrollment and premiums.
7. Finally, ensure that the employer representative signs and dates the form while providing their printed name and contact number.

Start using our platform today to easily fill out DSHS Form 14 252 online for free!