Employer statement of earnings 2025

1. Click ‘Get Form’ to open the employer statement of earnings in the editor.
2. Begin by entering the date sent and the employee's Social Security Number (SSN) at the top of the form.
3. Fill in the employee’s name and business name accurately to ensure proper identification.
4. In the Employee Permission section, have the employee sign and date to authorize sharing their employment information.
5. Complete the sections checked below, providing estimates for ongoing wages, including pay received or expected, projected hours per week, rate of pay per hour, and any tips or bonuses.
6. Indicate if this is a good indication of future earnings and provide explanations if necessary.
7. Fill out details regarding health insurance availability and type of pay along with pay period end dates and gross pay amounts.
8. For new employment, enter start dates and first check received; for ending employment, provide last date worked and final check details.
9. Complete normal scheduled work hours for each day of the week and indicate if the schedule varies.
10. Finally, fill in employer information including name, fax number, signature, phone number, and date before submitting.

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