Document Verification Form

Document Verification Form

Authorized Representative Completion (I-9 Section 2)
Employee Information (from Section 1 of Form I-9):
New Employee - Full Legal Name*
Citizenship/Immigration Status (Select One)*

US CitizenNoncitizen NationalLawful Permanent Resident (include Alien Registration Number/USCIS Number below)Alien Authorized to Work (include A-Number or Admission Number)
Alien Registration Number/USCIS Number or A-Number/Admission Number
List of Acceptable Documents Viewed
One from List A OR One from List B AND One from List C

List A – Documents that Establish Both Identity and Employment Authorization
Only one of these is needed if selected:
- U.S. Passport or Passport Card
- Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
- Foreign passport with a temporary I-551 stamp or I-551 printed notation
- Employment Authorization Document (EAD) that contains a photo (Form I-766)
- Passport from Micronesia or the Marshall Islands with Form I-94 or I-94A
- Foreign passport with Form I-94 indicating a nonimmigrant work-authorized status (for those authorized to work for a specific employer)
Document Title
Issuing Authority
Document Number
Expiration Date (if any)
List B – Documents that Establish Identity
Only accepted if presented with a List C document:

Driver’s license or ID card issued by a U.S. state or outlying territory with a photo or identifying information (name, date of birth, gender, height, eye color, and address)
- School ID card with a photograph
- Voter’s registration card
- U.S. military card or draft record
- Military dependent’s ID card
- U.S. Coast Guard Merchant Mariner Card
- Native American tribal document
- Driver’s license issued by a Canadian government authority
For individuals under age 18 who are unable to present one of the above:
- School record or report card
- Clinic, doctor, or hospital record
- Daycare or nursery school record
Document Title
Issuing Authority
Document Number
Expiration Date (if any)
List C – Documents that Establish Employment Authorization
Must be presented with a List B document:
- U.S. Social Security Card (not marked “Not valid for employment” or “Valid for work only with DHS/INS authorization”)
- Certification of Birth Abroad issued by the U.S. Department of State (Form FS-545 or Form DS-1350)
- Original or certified copy of birth certificate issued by a U.S. state, county, or municipality
- Native American tribal document
- U.S. Citizen ID Card (Form I-197)
- Identification Card for Use of Resident Citizen in the United States (Form I-179)
- Employment authorization document issued by DHS (other than Form I-766 from List A)
Document Title
Issuing Authority
Document Number
Expiration Date (if any)
Authorized Representative Attestation

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.
Signature*

Clear
Name*

First NameLast Name
Title*
Date*

MonthDayYear
Date
Business Name: Zen Dog Walking

Address: 7662 159th PL NE #732 Redmond WA 98052

Phone: (206) 432-4808

Anti-Discrimination Notice
Employers may not discriminate against individuals on the basis of national origin or citizenship status. For more information, contact the Immigrant and Employee Rights Section (IER) of the U.S. Department of Justice.
Representative Initials*
Storage and Compliance
- Maintain for 3 years after the date of hire or 1 year after termination, whichever is later.
- This form does not replace the Form I-9 but supplements Section 2 when completed by an authorized representative.
Should be Empty:

Document Verification Form

Employee Information (from Section 1 of Form I-9):

Authorized Representative Attestation