Step 10: Employment Verification Form

Employment Eligibility Verification
(U.S. Citizenship and Immigration Services Information)
This form is to assist with the completion of USCIS form I-9

Programs, services, and employment are equally available to everyone. Please inform the organization if you require reasonable accommodation for the application or interview or contact (800) 707-1852 option 0 and an operator will assist you. Read carefully before completing this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work -authorized individuals. Employers CANNOT specify which documents they will accept for an employee. The refusal to hire an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

* Indicates required field

Today's Date (IE: 06/18/1980) *

Position Applying For *

How were you referred to us? *

Name *

First

Last

Other Names Used (if any) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Birthday (IE:00/00/0000) *

Social Security # *

I attest, under penalty of perjury, that I am (check one of the following): *

A citizen of the United States A noncitizen national of the United States A lawful permanent resident An alien authorized to work until

Alien Registration /USCIS number or alien expiration date, if applicable, mm/dd/yyyy: *

Alien Registration Number o/ USCIS Number *

Form I-94 Admission Number *

If you obtained your admission number from CBP in connection with your arrival in the United States, Include the following:

Foreign Passport Number: *

Country of Issuance: *

Comment *

Submit

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Employment Eligibility Verification (U.S. Citizenship and Immigration Services Information) This form is to assist with the completion of USCIS form I-9

Employment Eligibility Verification
(U.S. Citizenship and Immigration Services Information)
This form is to assist with the completion of USCIS form I-9