Print Name: Last
First
Middle Initial
Maiden Name
Address
(Street Name and Number)
Apt. #
Date of Birth
(month/day/year)
City
State
Zip Code
Social Security #
I attest, under penalty of perjury, that I am (check one of the following):
A citizen or national of the United States
A Lawful Permanent Resident (Alien #) A
An alien authorized to work until
(Alien # or Admission #)
Section 2. Employer Review and Verification.
To be completed and signed by employer. Examine one document from List A OR
examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and expiration date, if
any, of the document(s).
Document title:
Issuing authority:
Document #:
Expiration Date(if any):
Document #:
Expiration Date(if any):
CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on (month/day/year)(中间是要添的空格)and that to the best of my knowledge the employee
I attest, under penalty of perjury, that I am (check one of the following):
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.
A Lawful Permanent Resident (Alien #) A
An alien authorized to work until
(Alien # or Admission #)
is eligible to work in the United States. (State employment agencies may omit the date the employee began employment.)
Signature of Employer or Authorized Representative
Print Name
Title
Business or Organization Name
Address(Street Name and Number, City, State, Zip Code)
Date(month/day/year)
Section 3. Updating and Reverification.To be completed and signed by employer.
A. New Name(if applicable)
B. Date of rehire(month/day/year) (if applicable)
C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility.
Document Title:
Document #:
这是一份表格,让我填,麻烦各位大师帮我翻译下,感激不尽!!!!
Expiration Date (if any):
因为这个是要填空的,所以希望各位在翻译的时候要对应的翻译,谢谢