Form 3 NC LRP - EVF Form - Revised 3

NURSE Corps Loan Repayment Program

NC LRP - EVF Form - Revised 3

Employment Verification Form

OMB: 0915-0140

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Example of updated text
Once your Employment verification is
completed by the site poc, the EV will
be available to view.
Please take time to view the EV to
ensure that all information is accurate
and reflects your current employment
status, salary and license information.
You will be required to verify that you
have reviewed the EV and that the
listed annual salary is accurate in the
Self Certification page

Example text change:
I certify that all of the information that I have provided in this application and the required
supplemental documents including the Employment verification that lists my base annual salary is
true.


File Typeapplication/pdf
File TitlePowerPoint Presentation
AuthorWesterlind, Michael (HRSA)
File Modified2020-02-04
File Created2019-11-05

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