All new employees are required by the provisions of the Immigration Reform and Control Act of 1982, to complete Form I-9, Employment Eligibility Verification. Effective April 3, 2009, I-9 forms for all new faculty, adjunct faculty, and student employees are to be completed in the Payroll department and I-9 forms for administrators and staff are to be completed in Human Resources. Student nurses/workers located at the hospitals may go to their respective Human Resources office. The purpose of the form below is to identify new faculty and student employees for I-9 verification. Please complete and submit the form below when an unconditional offer of employment has been accepted by the new faculty or student employee. This form must be completed prior to the first day of work / hire date.

Red fields are required.

First Name
Middle Name
Last Name
Birth Day	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Last 4 numbers of SSN	###-##-
Jag Number	J00######
Employee's Cell/Day Time Phone Number	###-###-####
Employee's Email Address
Employee Type	Permanent Faculty Adjunct Faculty Student Assistant Post Doctoral Work Study Graduate Assistant Nursing Student
Employed By	University USAMC USACW
Department
First Day of Work / Hire Date *	mm/dd/yyyy
I-9 Appointment Date **	mm/dd/yyyy
I-9 Appointment Time **	8 9 10 11 12 1 2 3 :   00 15 30 45 between 8:00 AM - 3:45 PM
Supervisor's Name
Supervisor's Work Number	###-###-####
Supervisor's Email Address
Contact Person
Contact Phone Number	###-###-####
Contact Email

Notes

• * = Students, and Adjunct Faculty - First day of work. Faculty - Hire Date (Date on PA form)
• ** = Supervisor to enter date and time for employee to arrive at Human Resources or Payroll. The appointment date can be any date after the applicant has accepted an unconditional offer of employment, but no later than the first day of work. The supervisor is to notify the employee of the I-9 appointment date/time and location for I-9 Verification.