Verification of Employment
Employee Information
First Name Last Name
Start Date (DD-MM-YYYY) Length of Employment
Please describe the scope of practice and duties performed by the employee:
Employer Contact Information
Company Name of Employer City & Country of Employment Location
First Name Last Name
Title Telephone Number
Email Relationship to Employee
Signature Date (DD-MM-YYYY)
The Employer must submit directly to COPR: [email protected]
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