PROVIDER VERIFICATION
Employee Name	Hire Date
Person Verifying Information	Date Verified
This is to certify that this employee is employed by Life's New Beginnings, Inc. and meets the minimum qualifications to provide the service indicated based on education and experience.
EDUCATION
Date Received – Diploma or GED	School Name	City/State

Degree	Date Received	Major	College/University Name	City/State

WORK EXPERIENCE
From	To	Hrs/Week	Employer Name	City/State	Job Title	Major Duties