Immigration Compliance Form

IMMIGRATION COMPLIANCE FORM

This Immigration Compliance Form (the "Agreement") is made effective as of by and between Company Name: with principal place of business at ("Employer") and Employee Name: residing at ("Employee").

RECITALS

WHEREAS, Employer engages individuals to perform work in the United States and is required to verify the identity and employment authorization of each individual in accordance with applicable immigration laws; and

WHEREAS, Employee asserts that Employee is authorized to work in the United States and agrees to provide accurate documentation and cooperate with reasonable verification and recordkeeping procedures; and

WHEREAS, the parties desire to set forth their respective obligations, certifications, and procedures to ensure compliance with immigration and employment eligibility requirements.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement: "Eligible to Work" means possessing lawful authorization to accept employment in the United States. "Documentation" means unexpired identity and employment authorization documents presented by Employee for inspection and retained by Employer as permitted by law. "Verification Period" means the time period in which Employer must complete verification procedures following hire or assignment.

2. EMPLOYEE REPRESENTATIONS AND CERTIFICATIONS

2.1 Employee represents and warrants that all information and documents provided to Employer for purposes of verifying identity and employment authorization are true, complete and genuine. Employee acknowledges that providing false or forged documentation is grounds for disciplinary action, up to and including termination.

2.2 Employee attests to the following (check all that apply):

U.S. citizen

U.S. national

Lawful permanent resident

Authorized nonimmigrant worker

3. DOCUMENTATION PROVIDED

Employee has presented the following document(s) for inspection. Employer has examined the original document(s) and recorded the following information:

4. EMPLOYER OBLIGATIONS

4.1 Employer shall inspect original documentation presented by Employee, make copies or records as permitted by law, and retain copies in accordance with applicable retention requirements. Employer shall not request more or different documents than are required for lawful verification.

4.2 Employer shall undertake nondiscriminatory verification practices and shall not base employment decisions on national origin, citizenship status, or on the type of document presented where the document reasonably appears to be genuine.

4.3 Employer may, at its discretion and consistent with applicable law, use electronic verification systems to verify employment authorization. Employer shall notify Employee in writing if electronic verification is used and provide any required employee rights notifications prior to verification.

5. VERIFICATION, AUDIT AND COOPERATION

5.1 Employer reserves the right to conduct audits of employment eligibility records and to request additional documentation to resolve questions about Employee's continuing authorization to work. Employee agrees to cooperate in a timely manner.

5.2 Failure by Employee to timely provide required documentation or to cooperate with verification procedures may result in suspension of work assignments or termination of employment consistent with applicable law.

6. RECORDKEEPING, PRIVACY AND DATA HANDLING

Employer will maintain documentation and records in a secure manner to protect privacy and limit access to authorized personnel. Records shall be kept in accordance with applicable retention requirements and destroyed in a manner that protects personal data when retention is no longer required.

7. REMEDIES, INDEMNIFICATION AND LIMITATION OF LIABILITY

7.1 Employee indemnifies and holds Employer harmless from claims, fines, penalties, costs and expenses arising from Employee's willful misrepresentation of identity or employment authorization.

7.2 Employer's actions taken in good faith to comply with applicable immigration laws shall not constitute a breach of this Agreement; Employer's liability for any claim arising out of verification procedures shall be limited to those damages directly resulting from Employer's proven willful or negligent misconduct.

8. NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth below by hand, certified mail, or other method providing proof of delivery.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

9.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflicts of law.

9.2 Entire Agreement. This Agreement, together with any attachments or employer-required forms appended hereto, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior negotiations, understandings and agreements.

9.3 Severability. If any provision of this Agreement is held to be invalid or unenforceable, the remainder of this Agreement shall remain in full force and effect, and the invalid or unenforceable provision shall be modified to the extent necessary to make it enforceable while preserving the parties' intent.

10. AMENDMENTS; WAIVER; COUNTERPARTS

10.1 Amendments. Any amendment to this Agreement must be in writing and signed by both parties.

10.2 Waiver. Failure or delay by either party to enforce a right shall not constitute a waiver of that right.

10.3 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

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