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EMPLOYMENT ELIGIBILITY FORM (USA)

Records right-to-work documents and identification verification

Add Your Company Name
Add Your Email Address
Add Your Phone Number
Add Your Address

Employee Information

Employee First Name *

First name input

Enter first name

Employee Last Name *

Surname input

Enter last name

Employee Email Address *

Enter email address

Phone Number *

Enter phone number

Date of Birth *

Select date...

Social Security Number *

XXX-XX-XXXX

Home Address *

Enter complete address

Right to Work Status

Citizenship Status *

Select option --

Options: U.S. Citizen, Lawful Permanent Resident, Authorized to work with expiration date, Other

Work Authorization Expiration Date (if applicable)

Select date...

Select date

Identity Verification Documents

Primary Identification Document Type *

Select option --

Options: Driver's License, Passport, State ID Card, Military ID, Other

Primary ID Document Number *

Enter document number

Primary ID Expiration Date *

Select date...

Primary ID Issuing Authority *

Enter issuing state/agency

Secondary Identification Document Type (if required)

Select option --

Options: Social Security Card, Birth Certificate, Voter Registration Card, School ID with Photo, Other, Not Applicable

Secondary ID Document Number

Enter document number if applicable

Document Uploads

Upload Primary ID Document (Front) *

Upload file...

Upload Primary ID Document (Back if applicable)

Upload file...

Upload Secondary ID Document (if applicable)

Upload file...

Upload Work Authorization Document (if applicable)

Upload file...

Attestation

I attest that I am authorized to work in the United States and that the information provided is true and complete *

Yes

I understand that falsifying information may result in denial of employment or termination *

Yes

Signature

Employee Signature *

Digital signature field

Additional Information

Additional Notes or Comments

Enter any additional information

How to Use This Template

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