verify.empinfo.com
Open in
urlscan Pro
34.226.161.245
Public Scan
URL:
https://verify.empinfo.com/employer/home?accessCode=bc6098b1-4d60-49b1-a07e-84dc30a9ad2e
Submission: On September 11 via manual from SG — Scanned from SG
Submission: On September 11 via manual from SG — Scanned from SG
Form analysis 2 forms found in the DOM
POST
<form class="needs-validation demo-container" id="registration" method="post" novalidate="novalidate">
<div class="card" id="employment_information_box">
<div class="card-header text-primary text-left font-weight-bold">
<div class="row">
<div class="col-md-6 brand-header">Employment Information</div>
<div class="col-md-6 text-md-right clickable">
<span id="external-report" class="mr-3" style="display: none;">
<a id="external-report-link" title="View 3rd party report" target="_blank" class="text-primary">
<i class="far fa-file-pdf" aria-hidden="true"></i> <span class="pl-2 brand-header" style="vertical-align: top;">View 3rd party report</span>
</a>
</span>
</div>
</div>
</div>
<div class="card-body">
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="job_title" class="required-field">Position</label> <input type="text" class="form-control" id="job_title" name="job_title" autocomplete="off" placeholder="Enter current / last position held">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="dept">Department</label> <input type="text" class="form-control" id="dept" name="dept" autocomplete="off" placeholder="Enter dept / division /branch">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="work_location">Work Location</label> <input type="text" class="form-control" id="work_location" name="work_location" autocomplete="off" placeholder="Enter city, state and zip">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="col-md-3 mb-3">
<label for="hiredate" class="required-field">Hire Date</label> <input type="text" class="form-control" id="hiredate" name="hiredate" autocomplete="off" placeholder="MM/DD/YYYY">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="rehiredate">Rehire Date (If Applicable)</label> <input type="text" class="form-control" id="rehiredate" name="rehiredate" autocomplete="off" placeholder="MM/DD/YYYY">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="status" class="required-field">Current Employment</label> <select class="custom-select" id="status" name="status" onchange="fnStatusChange(this.value)">
<option value="none">Status</option>
<option value="Active">Active</option>
<option value="Inactive">Inactive</option>
<option value="Terminated">Terminated</option>
<option value="Furlough">Furlough</option>
<option value="Other">Other</option>
</select>
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3" style="display: none;" id="labelCalendar">
<label for="statusdate" class="required-field">Status Start Date</label> <input type="text" class="form-control" id="statusdate" autocomplete="off" name="statusdate" placeholder="MM/DD/YYYY">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="employerComments">Remarks</label>
<input type="text" class="form-control" id="employerComments" name="employerComments" autocomplete="off" placeholder="">
<div class="invalid-feedback"></div>
</div>
<div id="terminationreason" class="col-md-6 mb-3 mb-md-0" style="display: none">
<div class="form-row">
<div class="col-md-6 mb-3 mb-md-0">
<label for="terminate_reason">Termination Reason</label> <input type="text" class="form-control" id="terminate_reason" autocomplete="off" name="terminate_reason" placeholder="">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-6">
<label for="eligiblestatus">Eligible for Re-hire</label> <select class="custom-select" id="eligiblestatus" name="eligiblestatus">
<option value="">Select</option>
<option value="N/A">N/A</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
<div class="invalid-feedback"></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="card mt-4" id="earningInformationDiv" style="display: none;">
<div class="card-header text-primary text-left font-weight-bold brand-header"> Income Information <a href="#" data-toggle="tooltip" data-placement="right" aria-describedby="income-section-tooltip" title="" data-original-title="If you do not have the income information, you could skip this section and CLICK on "SAVE & FORWARD" button below to forward to payroll or the concerned personnel">
<i class="fas fa-info-circle text-dark"></i>
</a>
</div>
<div class="card-body">
<div class="form-row" id="rate-of-pay-container">
<div class="col-md-3 mb-3" style="position: relative" id="salary-container">
<label for="salary" class="required-field">Wage (Salary / Hourly Rate)</label>
<input type="text" class="form-control" id="salary" name="salary" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('salary'); confirmRate();" placeholder="Amount" data-original-title="" title="">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3" id="showWeek-container">
<label for="showWeek" class="required-field">Per</label>
<select class="custom-select" id="showWeek" name="showWeek" onchange="fnShowAvgWeek(this.value); confirmRate();" data-toggle="popover">
<option value="none">Select</option>
<option value="Year">Year</option>
<option value="Hour">Hour</option>
<option value="Week">Week</option>
<option value="Monthly">Month</option>
<option value="Daily">Daily</option>
<option value="Other">Other</option>
</select>
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3" id="avgweek" style="display: none;">
<label for="average_hour" class="required-field">Avg. Hours / Week</label>
<input type="text" class="form-control" id="average_hour" autocomplete="off" name="average_hour" onblur="formattingForSalary('average_hour', true)" placeholder="Hours">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3" style="display: none;" id="payFrequencyDesc_div">
<label for="payfrequency_desc" class="required-field">Define Other Payment Mode</label>
<input type="text" class="form-control" id="payfrequency_desc" name="payfrequency_desc" autocomplete="off" onchange="confirmRate();" placeholder="">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3" id="pay-cycle-container">
<label for="pay-cycle" class="required-field">Pay Cycle</label>
<select class="custom-select" id="pay-cycle" name="pay-cycle">
<option value="none">Select</option>
<option value="Weekly">Weekly</option>
<option value="Bi-Weekly">Bi-Weekly</option>
<option value="Semi-Monthly">Semi-Monthly</option>
<option value="Monthly">Monthly</option>
</select>
<div class="invalid-feedback"></div>
</div>
</div>
<div id="income_right_clmn">
<div class="form-row">
<div class="col-md-3 mb-3" id="most_recent_check_date_label">
<label for="asofdate" class="required-field">Most Recent Check Date</label>
<div class="input-group date" data-provide="datepicker" data-date-end-date="0d" data-date-autoclose="true">
<input type="text" class="form-control" id="asofdate" name="asofdate" placeholder="MM/DD/YYYY" autocomplete="off">
<div class="input-group-append">
<span class="input-group-text"><i class="fas fa-calendar-alt"></i></span>
</div>
<div class="invalid-feedback"></div>
</div>
</div>
</div>
<div class="form-row" id="gross-earnings-title" style="display: none;">
<div class="col-6 font-weight-bold">Gross Earnings (US $)</div>
<div class="col-6 text-right earning-details-collapse-box" id="earning-details-expand-button">
<span class="earning-details-collapse-icon" id="earnings_expand_icon_box"><i class="fa clickable fa-angle-up" id="gross-earnings-arrow" style="vertical-align: top;"></i></span> <span class="earning-details-collapse-text">Earnings
Details</span>
</div>
</div>
<div class="form-row" id="gross_earnings_section" style="display: none;">
<div class="col-12 earning-table">
<table class="table table-striped mb-0">
<thead id="gross-summary-details-labels">
<tr>
<th scope="col">Type</th>
<th scope="col" id="l1_year11Label_th">
<span id="l1_year11Label"> </span> (YTD)
</th>
<th scope="col" id="l1_year21Label_th">
<span id="l1_year21Label"> </span>
<span class="year-checkbox-container">
<label class="checkbox-container form-check-label" for="l1_year2_checkbox">
<input class="form-check-input" autocomplete="off" type="checkbox" id="l1_year2_checkbox" onchange="onDataAvailableYear2()">
<span class="checkmark"></span>
</label>
</span>
</th>
<th scope="col" id="l1_year31Label_th">
<span id="l1_year31Label"> </span>
<span class="year-checkbox-container">
<label class="checkbox-container form-check-label" for="l1_year3_checkbox">
<input class="form-check-input" autocomplete="off" type="checkbox" id="l1_year3_checkbox" onchange="onDataAvailableYear3()">
<span class="checkmark"></span>
</label>
</span>
</th>
</tr>
</thead>
<thead style="display: none" id="gross-summary-details-paycheck-labels">
<tr>
<th scope="col">Type</th>
<th scope="col" colspan="2" id="l2_year11Label_th">
<span id="l2_year11Label"> </span>
</th>
<th scope="col" id="l2_year21Label_th">
<span id="l2_year21Label"> </span>
<span class="year-checkbox-container">
<label class="checkbox-container form-check-label" for="l2_year2_checkbox">
<input class="form-check-input" autocomplete="off" type="checkbox" id="l2_year2_checkbox" onchange="onDataAvailableYear2()">
<span class="checkmark"></span>
</label>
</span>
</th>
<th scope="col" id="l2_year31Label_th">
<span id="l2_year31Label"> </span>
<span class="year-checkbox-container">
<label class="checkbox-container form-check-label" for="l2_year3_checkbox">
<input class="form-check-input" autocomplete="off" type="checkbox" id="l2_year3_checkbox" onchange="onDataAvailableYear3()">
<span class="checkmark"></span>
</label>
</span>
</th>
</tr>
<tr class="font-size-0-7">
<th scope="col"></th>
<th scope="col" id="year11LabelSubLabel1"> Current Paycheck </th>
<th scope="col" id="year11LabelSubLabel2">YTD</th>
<th scope="col" id="ls2_year21Label"></th>
<th scope="col" id="ls2_year31Label"></th>
</tr>
</thead>
<tbody>
<tr id="base_year_row">
<th scope="row">Base</th>
<td style="display: none" id="base_paycheck_cell"><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('base_1_c');" id="base_1_c" class="form-control" placeholder="$"></td>
<td id="base_year1_cell"><input type="text" autocomplete="off" class="form-control" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('base_1');" id="base_1" placeholder="$"></td>
<td id="base_year2_cell"><input type="text" class="form-control" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('base_2');" id="base_2" placeholder="$"></td>
<td id="base_year3_cell"><input type="text" class="form-control" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('base_3');" id="base_3" placeholder="$"></td>
</tr>
<tr id="overtime_year_row">
<th scope="row">Overtime</th>
<td style="display: none" id="overtime_paycheck_cell">
<input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('over_time_1_c');" id="over_time_1_c" class="form-control" placeholder="$">
</td>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('over_time_1');" id="over_time_1" class="form-control" placeholder="$"></td>
<td id="overtime_year2_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('over_time_2');" id="over_time_2" class="form-control" placeholder="$"></td>
<td id="overtime_year3_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('over_time_3');" id="over_time_3" class="form-control" placeholder="$"></td>
</tr>
<tr id="bonus_year_row">
<th scope="row">Bonus</th>
<td style="display: none" id="bonus_paycheck_cell"><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('bonus_1_c');" id="bonus_1_c" class="form-control" placeholder="$"></td>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('bonus_1');" id="bonus_1" class="form-control" placeholder="$"></td>
<td id="bonus_year2_cell"><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('bonus_2');" id="bonus_2" class="form-control" placeholder="$"></td>
<td id="bonus_year3_cell"><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('bonus_3');" id="bonus_3" class="form-control" placeholder="$"></td>
</tr>
<tr id="commission_year_row">
<th scope="row">Commission</th>
<td style="display: none" id="commission_paycheck_cell">
<input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('commission_1_c'); " id="commission_1_c" class="form-control" placeholder="$">
</td>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('commission_1');" id="commission_1" class="form-control" placeholder="$"></td>
<td id="commission_year2_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('commission_2');" id="commission_2" class="form-control" placeholder="$"></td>
<td id="commission_year3_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('commission_3');" id="commission_3" class="form-control" placeholder="$"></td>
</tr>
<tr id="stocks_year_row">
<th scope="row">Stocks</th>
<td style="display: none" id="stocks_paycheck_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('stocks_1_c');" id="stocks_1_c" class="form-control" placeholder="$"></td>
<td><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('stocks_1');" id="stocks_1" class="form-control" placeholder="$"></td>
<td id="stocks_year2_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('stocks_2');" id="stocks_2" class="form-control" placeholder="$"></td>
<td id="stocks_year3_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('stocks_3');" id="stocks_3" class="form-control" placeholder="$"></td>
</tr>
<tr id="others_year_row">
<th scope="row">Others</th>
<td style="display: none" id="others_paycheck_cell"><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('others_1_c');" id="others_1_c" class="form-control" placeholder="$"></td>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('others_1');" id="others_1" class="form-control" placeholder="$"></td>
<td id="others_year2_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('others_2');" id="others_2" class="form-control" placeholder="$"></td>
<td id="others_year3_cell"><input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('others_3');" id="others_3" class="form-control" placeholder="$"></td>
</tr>
<tr class="gross_total_row" id="gross_total_row">
<th scope="row" class="required-field align-top">Gross Total</th>
<td style="display: none" id="total_paycheck_cell" data-toggle="popover">
<div class="input-group" id="paycheck_input-group">
<div class="input-group-prepend" onclick="showSumPayCheck();">
<div class="input-group-text">Σ</div>
</div>
<input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('total_1_c')" id="total_1_c" name="total_1_c" class="form-control" placeholder="$">
</div>
</td>
<td id="total_year1_cell" data-toggle="popover">
<div class="input-group" id="total_1_input-group">
<div class="input-group-prepend" onclick="showSumTotalYear1();">
<div class="input-group-text">Σ</div>
</div>
<input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('total_1')" id="total_1" name="total_1" class="form-control" placeholder="$">
</div>
</td>
<td id="total_year2_cell" data-toggle="popover">
<div class="input-group" id="total_2_input-group">
<div class="input-group-prepend" onclick="showSumTotalYear2();">
<div class="input-group-text">Σ</div>
</div>
<input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('total_2')" id="total_2" name="total_2" class="form-control" placeholder="$">
</div>
</td>
<td id="total_year3_cell" data-toggle="popover">
<div class="input-group" id="total_3_input-group">
<div class="input-group-prepend" onclick="showSumTotalYear3();">
<div class="input-group-text">Σ</div>
</div>
<input autocomplete="off" type="text" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('total_3')" id="total_3" name="total_3" class="form-control" placeholder="$">
</div>
</td>
</tr>
<tr id="net_paycheck_row" style="display: none">
<th scope="row" class="required-field">Net</th>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('net_1_c')" id="net_1_c" name="net_1_c" class="form-control" placeholder="$"></td>
<td></td>
<td id="net_year2_cell"></td>
<td id="net_year3_cell"></td>
</tr>
<tr id="garnishment_paycheck_row" style="display: none">
<th scope="row">Garnishment Deduction</th>
<td><input type="text" autocomplete="off" onkeypress="return isNumberKey(event)" onblur="formattingForSalary('garnishment_1_c')" id="garnishment_1_c" name="garnishment_1_c" class="form-control" placeholder="$"></td>
<td></td>
<td id="garnishment_year2_cell"></td>
<td id="garnishment_year3_cell"></td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="form-row" id="pay_raise_box" style="display: none;">
<div class="col-md-3 mb-3 mb-md-0">
<label for="last_pay_rise_on">Last Pay Raise On</label> <input type="text" autocomplete="off" class="form-control" id="last_pay_rise_on" name="last_pay_rise_on" placeholder="MM/DD/YYYY">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3 mb-md-0">
<label for="last_pay_increase">Amount</label> <input type="text" autocomplete="off" onblur="formattingForSalary('last_pay_increase')" id="last_pay_increase" name="last_pay_increase" class="form-control text-right" placeholder="$">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3 mb-md-0 separator">
<label for="next_pay_rise_on">Next Pay Raise On</label> <input type="text" autocomplete="off" class="form-control" id="next_pay_rise_on" name="next_pay_rise_on" placeholder="MM/DD/YYYY">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3 mb-md-0">
<label for="next_pay_increase">Amount</label> <input type="text" autocomplete="off" onblur="formattingForSalary('next_pay_increase')" class="form-control text-right" id="next_pay_increase" name="next_pay_increase" placeholder="$">
<div class="invalid-feedback"></div>
</div>
</div>
</div>
</div>
</div>
<div class="card mt-4" id="questions" style="display: none;">
<div class="card-body" id="dynamic-questions-here"></div>
</div>
<div class="card mt-4" id="benefits-box" style="display: none;">
<div class="card-header text-primary text-left font-weight-bold">
<div class="row">
<div class="col-12 brand-header">Benefits</div>
</div>
</div>
<div class="card-body">
<div>
<div class="d-flex">
<label style="margin-top: 10px" class="required-field"> Does your company offer Long-Term-Disability (LTD) Insurance to the Employee? </label>
<label class="radio-container ml-3">
<span class="checkbox-label">Yes</span>
<input type="radio" name="ltd-insurance" value="Yes">
<span class="checkmark"></span>
</label>
<label class="radio-container ml-3">
<span class="checkbox-label">No</span>
<input type="radio" name="ltd-insurance" value="No">
<span class="checkmark"></span>
</label>
</div>
<div class="invalid-feedback"></div>
</div>
<div class="mt-3" id="ltd-paid-by-box" style="display: none;">
<div class="d-flex">
<label class="required-field" style="margin-top: 10px;">Who pays for LTD Insurance?</label>
<label class="radio-container ml-3">
<span class="checkbox-label">Employee</span>
<input type="radio" name="ltd-paid-by" value="Employee">
<span class="checkmark"></span>
</label>
<label class="radio-container ml-3">
<span class="checkbox-label">Employer</span>
<input type="radio" name="ltd-paid-by" value="Employer">
<span class="checkmark"></span>
</label>
</div>
<div class="invalid-feedback"></div>
</div>
</div>
</div>
<div class="card mt-4" id="tnc_box">
<div class="card-body py-2">
<div class="form-group tnc">
<div class="form-check pl-0">
<input class="form-check-input checkbox-input" autocomplete="off" type="checkbox" value="None" id="termsofuse" name="termsofuse">
<label class="form-check-label ml-0 pl-0" for="termsofuse"> I am authorized by our organization to respond to the employment and/or income verification </label>
<div class="invalid-feedback"></div>
</div>
</div>
</div>
</div>
<div class="card mt-4" id="authorized_personal_details_box">
<div class="card-body">
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="first_name" class="required-field">Name</label> <input autocomplete="off" type="text" class="form-control" id="first_name" name="first_name" placeholder="Enter your full name">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-6 mb-3">
<label for="emp_job_title">Title</label> <input autocomplete="off" type="text" class="form-control" id="emp_job_title" name="emp_job_title" placeholder="Enter your Job Title">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="email" class="required-field">Email (work)</label> <input autocomplete="off" type="text" class="form-control" id="email" name="email" placeholder="Enter your email address at work">
<label id="email-alert" style="display: inline; display: none; font-size: 12px !important; left: 105px"></label>
<span id="email-inline-spinner" class="agent-email-inline-block" style="bottom: 3px;"></span>
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="phone" class="required-field">Phone (work)</label>
<input type="text" class="form-control" id="phone" name="phone" autocomplete="off" placeholder="xxx-xxx-xxxx" maxlength="12">
<div class="invalid-feedback"></div>
</div>
<div class="col-md-3 mb-3">
<label for="ext">Ext</label> <input autocomplete="off" type="text" class="form-control" id="ext" placeholder="Enter Ext" name="ext" maxlength="6">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="num-of-act-emp">Number of active employees</label>
<select class="custom-select" id="num-of-act-emp" name="num-of-act-emp">
<option value="none">Please select one</option>
<option value="<500">< 500</option>
<option value="500-999">500-999</option>
<option value="1000-4999">1000-4999</option>
<option value="5000-10000">5000-10000</option>
<option value=">10000">> 10000</option>
</select>
<div class="invalid-feedback"></div>
</div>
<div class="col-md-6 mb-3">
<label for="hris-payroll">HR / Payroll system</label>
<select class="custom-select" id="hris-payroll" name="hris-payroll" onchange="fnHrisChange(this.value)">
<option value="none">Please select one</option>
<option value="ADP">ADP</option>
<option value="Bamboo">Bamboo</option>
<option value="Gusto">Gusto</option>
<option value="Namely">Namely</option>
<option value="Paycom">Paycom</option>
<option value="Paychex">Paychex</option>
<option value="Paylocity">Paylocity</option>
<option value="Quickbooks">Quickbooks</option>
<option value="Rippling">Rippling</option>
<option value="Square">Square</option>
<option value="UKG Pro">UKG Pro</option>
<option value="UKG Ready">UKG Ready</option>
<option value="Workday">Workday</option>
<option value="Zenefits">Zenefits</option>
<option value="Other">Other</option>
</select>
<div class="invalid-feedback"></div>
</div>
</div>
<div class="form-row" style="display: none" id="other-hris-payroll-row">
<div class="col-md-6 mb-3"></div>
<div class="col-md-6 mb-3">
<label for="other-hris-payroll" class="required-field">Other HR/Payroll System</label>
<input autocomplete="off" type="text" class="form-control" id="other-hris-payroll" name="other-hris-payroll" placeholder="">
<div class="invalid-feedback"></div>
</div>
</div>
</div>
</div>
<div class="text-right demo-padding">
<button type="submit" id="SaveAndForward" class="btn btn-secondary btn-custom-secondary" onclick="fnbuttonClick(2);" style="display: none;">Save & Forward to Payroll </button>
<button type="submit" id="Preview" class="ml-2 btn btn-primary" onclick="fnbuttonClick(1);">Confirm & Submit </button>
</div>
<input type="hidden" id="buttonclick" value=""> <input type="hidden" id="accessCode" value="bc6098b1-4d60-49b1-a07e-84dc30a9ad2e"> <input type="hidden" id="verified_for_hidden" value="1"> <input type="hidden" id="gross-hidden-earnings" value="2">
<input type="hidden" id="year1" value=""> <input type="hidden" id="year2" value="">
<input type="hidden" id="year3" value=""> <input type="hidden" id="emp_employeeFirstName" value="Michael Hackley"> <input type="hidden" id="emp_employeeSocial" value="SSN: xxx-xx-9912"> <input type="hidden" id="emp_employeeWorkEmail" value="">
<input type="hidden" id="emp_employeeWorkPhone" value=""> <input type="hidden" id="emp_verifierCompanyName" value="HireRight Tulsa"> <input type="hidden" id="emp_verifierCompanyStreetAddress" value="14002 East 21st Street"> <input type="hidden"
id="emp_verifierCompanyState" value=""> <input type="hidden" id="emp_verifierCompanyPhone" value=""> <input type="hidden" id="emp_vverifierEmail" value=""> <input type="hidden" id="emp_verificationType" value="Employment"> <input type="hidden"
id="emp_consentId" value=""> <input type="hidden" id="emp_isDigitalConsent" value="false"> <input type="hidden" id="emp_permissiblePurpose" value="Employment Purpose">
</form>POST
<form class="needs-validation" id="payroll_Modal" method="POST" novalidate="novalidate">
<div class="modal-header">
<h5 class="modal-title text-primary" id="payrollModalLabel">Forward to Payroll for Income Verification</h5>
<button type="button" class="close" data-dismiss="modal" aria-label="Close">
<span aria-hidden="true">×</span>
</button>
</div>
<div class="modal-body">
<div class="form-group">
<label for="payrollEmail" class="col-form-label required-field">Recipient:</label>
<input type="text" class="form-control" id="payrollEmail" autocomplete="off" name="payrollEmail" placeholder="Enter Payroll Personnel Email">
<div class="invalid-feedback"></div>
</div>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-secondary" data-dismiss="modal">Cancel </button>
<button type="submit" id="popupSubmit" class="btn btn-primary">Send</button>
</div>
</form>Text Content
Request for Verification of Employment (for Michael Hackley) Order Number E-090123-987975 Requested for Employee Michael Hackley SSN/Employee ID SSN: xxx-xx-xxxx Employee Consent View Consent Requested By HireRight Tulsa 14002 East 21st Street Tulsa, OK, 74134 Permissible Purpose Employment Purpose Employment Information View 3rd party report Position Department Work Location Hire Date Rehire Date (If Applicable) Current Employment Status Active Inactive Terminated Furlough Other Status Start Date Remarks Termination Reason Eligible for Re-hire Select N/A Yes No Income Information Wage (Salary / Hourly Rate) Per Select Year Hour Week Month Daily Other Avg. Hours / Week Define Other Payment Mode Pay Cycle Select Weekly Bi-Weekly Semi-Monthly Monthly Most Recent Check Date Gross Earnings (US $) Earnings Details Type (YTD) Type Current Paycheck YTD Base Overtime Bonus Commission Stocks Others Gross Total Σ Σ Σ Σ Net Garnishment Deduction Last Pay Raise On Amount Next Pay Raise On Amount Benefits Does your company offer Long-Term-Disability (LTD) Insurance to the Employee? Yes No Who pays for LTD Insurance? Employee Employer I am authorized by our organization to respond to the employment and/or income verification Name Title Email (work) Phone (work) Ext Number of active employees Please select one < 500 500-999 1000-4999 5000-10000 > 10000 HR / Payroll system Please select oneADPBambooGustoNamelyPaycomPaychexPaylocityQuickbooksRipplingSquareUKG ProUKG ReadyWorkdayZenefitsOther Other HR/Payroll System Save & Forward to Payroll Confirm & Submit About Us Terms & Conditions Security FCRA 2023 © EmpInfo Inc. All rights reserved. FORWARD TO PAYROLL FOR INCOME VERIFICATION × Recipient: Cancel Send CONFIRM & SUBMIT × Job Title: Hire Date: Rehire Date: Status: Status Date: Termination Reason: Eligible for Re-hire: Department: Work Location: Remarks: Rate of Pay: / Avg. Hours / Week: Pay Cycle: Most Recent Check Date: Type Type Current Paycheck YTD Base Overtime Bonus Commission Stocks Others Gross Total Net Garnishment Deduction Last Pay Raise On: on Next Pay Raise On: on Does your company offer Long-Term-Disability (LTD) Insurance to the Employee?: Who pays for LTD Insurance?: Edit Submit EMPLOYEE CONSENT × Questions? Feedback? powered by Olark live chat software