Self Employment Verification Form



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Do you have a business license to conduct business in Stanislaus County or a neighboring county (If so, please attach) Do you have a professional license (If so, please attach) Is your office or place of work also your residence or located at your residence Is your office or place of work a rented property Do you have regular business hours (If so, please attach) Do you work for others on a contract basis Do you have advertising materials (If so, please attach) Please check the appropriate box below and describe the primary nature of your self-employment: Sales (real estate, retail business, etc.) Landscape / Gardening (landscaping, landscape design, etc.) Domestic (house-cleaning business, etc.) Trucking (owns truck/trucking business, works for a company as an independent contractor, etc.) Other (Please describe.) Please select the box that best describes the basis for your income and tell how much you typically earn for that item and how many of those items you would be paid for in a month..

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