Employment and Wage Verification Statement (English) Number: CCA-0024A Effective Date: Monday, November 1, 2021 Type: Forms File: PDF Static forms need to be printed and completed manually.Business name: Contact Person: Address: City: State: Zip: Telephone Number: Start Date of Employment: Hourly Rate of Pay: Days of week worked: Monday. The Ccis Employment Verification Form is an official document designed to authenticate and detail an employee's work status, schedule, and income.