I9 - Esparza Enterprises

Hidden

Today's Date

Hidden

Initial Checkbox 1

Yes

I9 - Part 1

Date(Required)

EE#:

Social Security #:(Required)

Date of Birth:(Required)

Name:(Required)

First Name Middle Iniitial Last Name

Email Address:

Address:(Required)

Street Address Apt/Unit# City State ZIP Code

Telephone:(Required)

USCIS Form I-9 - Employment Eligibility Verification

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation

(Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

Other Last Names Used:

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

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

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):

Alien Registration Number/USCIS Number):

Expiration Date:

Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number:

- OR -

2. Form I-94 Admission Number:

- OR -

Foreign Passport Number:

Country of Issuance:

Signature of Employee:(Required)

Click Here to Download Policy Documents

Preparer and/or Translator Certification:

Hidden

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

I did not use a preparer or translator.

Hidden

Signature of Preparer or Translator:

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Hidden

Last Name (Family Name):

Hidden

First Name (Given Name):

Employer's Business or Organization Name
Esparza Enterprises, Inc.

Employer's Business or Organization Address
3851 Fruitvale Ave, Bakersfield, CA 93308

Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

Citizenship/Immigration Status:

Identity and Employment Authorization:(Required)

List A

List B & List C

List A

Identity and Employment Authorization

Document Title:

Issuing Authority:

Document Number:

Expiration Date:

Document Title:

Issuing Authority:

Document Number:

Expiration Date:

Document Title:

Issuing Authority:

Document Number:

Expiration Date:

List B

Identity

Document Title:

Issuing Authority:

Document Number:

Expiration Date:

List C

Employment Authorization

Document Title:

Issuing Authority:

Document Number:

Expiration Date:

Additional Information:

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

The Employee's First Day of Employment:

(See instructions for exemptions)

Signature of Employer or Authorized Representative:(Required)

Title of Employer or Authorized Representative:(Required)

First Name of Employer or Authorized Representative:(Required)

Last Name of Employer or Authorized Representative:(Required)

Employer's Business or Organization Name
Esparza Enterprises, Inc.

Employer's Business or Organization Address
3851 Fruitvale Ave, Bakersfield, CA 93308

Comments

This field is for validation purposes and should be left unchanged.