Acceleration HR Test Everify

Employment Eligibility Verification
U.S. Citizenship and Immigration Services

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Check this box to provide all other names used, if any (including maiden name). If you have had no other legal names, you may leave this box unchecked.

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):

A Citizen of the United States

A non citizen national of the United States

A lawful permanent resident (Alien Registration Number/USCIS Number)

An alien authorized to work until:

My employment authorization does not expire.
My employment expires on

My:

Alien Registration Number/USCIS Number

I-94 Admission Number

Foreign Passport

List A Document

List B & C Document

List A

U.S. Passport or U.S. Passport Card

Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa

Employment Authorization Document that contains a photograph (Form I-766)

For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

Foreign passport; and
Form I-94 or Form I-94A that has the following:

The same name as the passport; and
An endorsement of the alien's nonimmigrant status, as long as the period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

A passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

List B

Driver's license or ID card issued by a state or outlying possession of the United States, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

Drivers License
ID Card

Document Does not expire

ID card issued by federal, state, or local government agencies or entities, provided it contains a photograph or information such as 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 persons under age 18 who are unable to present a document listed above:

School record or report card

Clinic, doctor, or hospital record

Day-care or nursery school record

List C

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

Certification of Birth Abroad issued by the Department of State (Form FS-545)

Certification of Report of Birth issued by the Department of State (Form DS-1350)

Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

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 the Department of Homeland Security

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