I9 Employer Verification – Ponderosa

You can open each page of the I9 here if you wish to review the information on the individual pages.
Page 1. Employee Information and Attestation (Employee Completed at Onboarding)
Page 2. Employer or Authorized Representative Review and Verification (Current Form)
Page 3. Lists Of Acceptable Documents

LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

From which list are you verifying a document(Required)

LIST A

Documents that Establish Both Identity and Employment Authorization

Click to view document: E xamples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts.

Select a document from List A #1(Required)

You are only required to enter one document from List A. Additional entries may be added at your discretion.

Document Title #1(Required)

Issuing Authority #1(Required)

Document Number #1(Required)

Expiration Date (if any)(mm/dd/yyyy) #1

Do you have an additional document from list A #2(Required)

Select a document from List A #2(Required)

Document Title #2(Required)

Issuing Authority #2(Required)

Document Number #2(Required)

Expiration Date (if any)(mm/dd/yyyy) #2

Do you have an additional document from list A #3(Required)

Select a document from List A #3(Required)

Documents that Establish Both Identity and Employment Authorization

Document Title #3(Required)

Issuing Authority #3(Required)

Document Number #3(Required)

Expiration Date (if any)(mm/dd/yyyy) #3

LIST B

Documents that Establish Identity

Click to view document: E xamples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts.

Is this person under age 18

Select a document from List B(Required)

List B: For persons under age 18 who are unable to present a document listed above:

Document Title(Required)

Issuing Authority(Required)

Document Number(Required)

Expiration Date (if any)(mm/dd/yyyy)

LIST C

Documents that Establish Employment Authorization

Click to view document: E xamples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts.

Select a document from List C(Required)

A Social Security Account Number card, unless the card includes one of the following restrictions:

(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

Document Title(Required)

Issuing Authority(Required)

Document Number(Required)

Expiration Date (if any)(mm/dd/yyyy)

Certification

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.Lists Of Acceptable Documents.

The employee's first day of employment(Required)

You may find this information on page 1 of the I9

Signature of Employer or Authorized Representative(Required)

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Today's Date(Required)

Title of Employer or Authorized Representative(Required)

Last Name of Employer or Authorized Representative(Required)

First Name of Employer or Authorized Representative(Required)

Employer's Business or Organization Name(Required)

Employer's Business or Organization Address (Street Number and Name)(Required)

City or Town(Required)

State(Required)

Zip Code(Required)

Section 3. Reverification and Rehires

(To be completed and signed by employer or authorized representative.)

A. New Name (if applicable) – Please enter complete name, including middle initial (if any) regardless if there was a name change, as this document will be an additional document added to the original I9

Last Name – Re-Hire(Required)

First Name – Re-Hire(Required)

Middle Initial – Re-Hire

B. Date of Rehire (if applicable) – Please enter date of re-hire as this document will be an additional document added to the original I9

Date of Re-Hire(Required)

C. If the employee’s previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Document Title – Re-Hire

Document Number – Re-Hire

Expiration Date (if any) – Re-Hire

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative – Re-Hire(Required)

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Today's Date – Re-Hire(Required)

Name of Employer or Authorized Representative – Re-Hire(Required)

Additional Information

Comments

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

Section 2. Employer or Authorized Representative Review and Verification

Employee Info from Section 1

LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

Documents that Establish Both Identity and Employment Authorization

LIST B

Documents that Establish Identity

LIST C

Documents that Establish Employment Authorization

Certification

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Section 3. Reverification and Rehires

(To be completed and signed by employer or authorized representative.)

A. New Name (if applicable) – Please enter complete name, including middle initial (if any) regardless if there was a name change, as this document will be an additional document added to the original I9

B. Date of Rehire (if applicable) – Please enter date of re-hire as this document will be an additional document added to the original I9

C. If the employee’s previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Additional Information

Section 2. Employer or Authorized Representative Review and Verification

Employee Info from Section 1

LISTS OF ACCEPTABLE DOCUMENTSAll documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

Documents that Establish Both Identity and Employment Authorization

LIST B

Documents that Establish Identity

LIST C

Documents that Establish Employment Authorization

Certification

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Section 3. Reverification and Rehires

(To be completed and signed by employer or authorized representative.)

A. New Name (if applicable) – Please enter complete name, including middle initial (if any) regardless if there was a name change, as this document will be an additional document added to the original I9

B. Date of Rehire (if applicable) – Please enter date of re-hire as this document will be an additional document added to the original I9

C. If the employee’s previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

If you are using a mobile phone or tablet to complete this document, please turn the device horizontal to display the entire signature box.

Additional Information

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LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED