Form 1729, Applicant Verification for Employees

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Documents

Effective Date: 7/2024

Instructions

Updated: 7/2024

Purpose

To verify and document that the applicant qualifies and is eligible to be employed by the Consumer Directed Services (CDS) employer.

This form also serves as the Financial Management Services Agency (FMSA) applicant verification form. The FMSA must verify all applicants before the CDS employer can hire them.

To certify by employer and applicant signature that the applicant:

  • meets the qualifications and criteria for employment, or
  • does not meet one or more of the qualifications and criteria for employment.

Procedure

When to Prepare

The employer must complete this form with each applicant before the employer can hire the applicant or rehire a former employee.

Number of Copies

Original and one copy.

Transmittal

The employer keeps the original or a copy in the employee's personnel file and sends the original or a copy to the FMSA when the form is completed.

Form Retention

The employer must keep this form while in effect plus five years after termination of employment or until resolution of all outstanding litigation, claims and audits.

Detailed Instructions

Person’s Name — Enter the name of the person receiving services.

Employer Name — Enter the name of the employer.

Applicant Name — Enter the name of the applicant.

Applicant Social Security No. — Enter the applicant's Social Security number.

Employment Qualifications

The employer must verify the applicant meets each criterion. The employer enters a check mark to indicate the criterion is met. The employer must make sure the forms, copies of documentation used to verify the criteria or both are valid and kept in the employee's personnel file.

The employer sends Form 1729 and supporting documentation to the FMSA for verification before the applicant can be hired.

FMSA Certification and Acknowledgment

The FMSA enters a check mark to indicate the applicant either does or does not meet all employment qualifications.

Employer Signature, Date — The employer signs and dates the form to acknowledge the applicant meets employment qualifications and that a copy of this form is submitted to the FMSA.

The employer sends Form 1729 and supporting documentation to the FMSA for verification before they can hire the applicant.

FMSA Signature, Date — The FMSA must sign and date this form to certify the applicant either qualifies for employment or does not. Once the FMSA signs this form and sends it back to the employer, the employer may hire the applicant if the applicant qualifies for employment.