HR E-Verify Processing Form

HR E-Verify Processing Form

Personal Information

Full Legal Name:

Date of Birth:    Social Security Number:

Position Information

Reporting Manager:    Anticipated Start Date:

Employment Type: Full-time Part-time Temporary/Seasonal

Employment Eligibility / Immigration Status

Select the option that describes your current status (select one):

U.S. Citizen
Noncitizen National of the United States
Lawful Permanent Resident (provide Alien Registration Number):
Authorized to work until:

Form I‑9 Documents Presented

List the document(s) presented for identity and employment authorization. Provide one entry for each document presented. Photocopy permission: I authorize photocopying of presented documents for the employer's Form I‑9 file.

E‑Verify Authorization and Consent

By checking the box below, I hereby authorize the employer to create an E‑Verify case in my name and to transmit my Form I‑9 information, including my name, date of birth, Social Security number, and citizenship/immigration status, to the appropriate government agency for employment eligibility verification. I understand that this information will be used only for the purpose of verifying employment authorization and that the employer will retain records in accordance with applicable law.

I authorize the employer to submit my information to E‑Verify and to receive and act upon the result.

Authorization to Contact Previous Employers / Background Check

I authorize the employer and its designated agents to contact my prior employers and references and to obtain background check information, criminal history, and other records as permitted by law for purposes of evaluating my qualifications for employment. I understand that certain checks may require additional written authorization and that I may be required to complete separate forms.

I consent to employer-conducted background checks and prior employer verifications.

Employer Processing (HR Use Only)

E‑Verify Case Number:    Case Created On:

Employment History (Most Recent First)

Title:   Dates Employed:

Title:   Dates Employed:

Education

Graduation Date:

Professional References

Phone:    Email:

Phone:    Email:

Phone:    Email:

Legal Disclosures and Acknowledgements

At‑Will Employment: I understand that nothing in this form or in any communications by the company creates a contract of employment for any specified period of time. Employment, if offered and accepted, is at‑will and may be terminated by either party at any time, with or without cause or notice, unless otherwise agreed in a separate written agreement signed by an authorized representative of the employer.

Equal Employment Opportunity: The employer is an equal opportunity employer. Employment decisions are based on merit, qualifications, and business needs. The employer does not discriminate on the basis of protected characteristics as defined by applicable law.

Applicant Certification

I certify that all information provided in this form is true, complete, and correct to the best of my knowledge. I understand that any falsification or omission of material facts may result in denial of employment or termination if employed. I authorize the release of information from prior employers, educational institutions, and references as necessary to verify the information provided.

I certify the statements above and consent to verification as described.

Sign Now