If you hire us, the info
you submit will be used to create your E-Verify account. Please check for
accuracy and completeness. |
| Legal Business Name* |
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| DBA Name |
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| Enter the name of
your corporate or parent company, if applicable: |
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| Which category best
describes your company's organization? |
| Organization Type* |
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| Enter your Federal
ID number. If you do not have an ID number (ex., sole
proprietorship), submit your Social Security number: |
| Federal ID Number* |
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| Enter total number of employees
including part-time and seasonal workers: |
| Number of Employees* |
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Number of offices in which I-9
forms are received and processed. If I-9 forms will be submitted for
verification from more than one office, select `Multiple Workplaces.` |
| Workplaces* |
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Enter your primary
physical address: |
| Physical Address* |
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| City, State, Zip* |
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| County or Parish* |
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If your mailing address is
different, include it below: |
| Mailing Address |
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| City, State, Zip |
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Enter your primary phone numbers
below: |
| Primary Phone* |
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| Fax* |
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Name of the person who will be the primary contact for the
verification program. First and last name, please: |
| Contact Name* |
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Primary contact's email address. All verification
responses and other notices will be sent to this address: |
| Email Address* |
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Contact's phone and extension: |
| Contact Phone* |
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If you become our
client, you will use this login info to access
special client-only features at our site: |
| Preferred User Name |
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| Password |
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How do you want to receive the information that you are requesting? |
| Contact Method* |
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| Please describe
your organization or business purpose... services or products; consulting; city
or county; etc. If you know your
NAICS code, just
enter it: |
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| How Did You Find Out About Us? |
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