The University form lets eligible West Campus, HSC, and Research Foundation employees
select the employment information to include: name, Social Security number, title,
department, base salary, location pay (UUP & Civil Service only), dates of employment,
hire date, separation date, or other information.
Indicate your employer (State, Research Foundation, or both), the individual receiving
the information, and your preferred delivery method on the form: pick-up, email, fax,
or mail. These are the form’s delivery choices for the completed verification, rather
than additional online submission options.
Complete the requester details, authorization, date, and signature. The authorization
can be withdrawn or changed by completing a new form. Letters/forms containing a Social
Security number will not be transmitted via email.