Arkansas department of human services verification of earnings 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the employee's start date and hourly wage in the designated fields. Specify the average hours worked per week and the anticipated gross amount for the first paycheck.
3. In the earnings section, list each paycheck separately, including any bonuses or vacation pay. Ensure you provide details such as pay period dates, hours worked, and gross wages.
4. If applicable, indicate whether any earnings are funded by JTPA - On The Job Training Program by selecting 'Yes' or 'No'.
5. If the employee is no longer employed, fill in their termination date and reason for leaving.
6. Provide additional information regarding expected changes in employment status, such as layoffs or raises.
7. Lastly, complete the insurance section if applicable, detailing the insurance carrier's name and address along with policy information.
8. Ensure that an authorized signature is provided at the bottom of the form along with the date and place of business.

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