1
a. Employer ID: _[pre-filled]__
b. Case Number: _[pre-filled]__
Employee Record Review Form
c. Employee Name: : _[pre-filled]__
d. Employee SSN: _[pre-filled]__
e. Employee Address on I-9:
f. Alternate Address (if different from address on I-9):
g. Employee Phone:
h. Employee file contains: (check all that apply.)
___ Form I-9
___ Copy of system response --> number of responses
___ TNC notice
___ Referral letter to SSA
___ Referral letter to DHS
___ Copies of documents used for verification (Please specify, e.g., driver’s license, current passport, permanent resident card, etc.)
___ Other (Please specify)
i. Current work authorization status: _[pre-filled]__
If there is a reason to believe this is incorrect, please explain:
j. Reviewer: _
___________________
k. Review Date: __________________
2
Employee Record Review Form ([prefilled name]/[ prefilled SS# ])
Case #: _____[CASE_NBR]___
1. Items To Be Reviewed
2. Information from
Transaction Database
3. Does (2) match the
employee's record
file?
4. Information from
Employee's Record
5. Comments
6. Name (I-9)
Last
First
Middle Initial
[prefilled]
__yes __no
__yes __no
__yes __no
7. Date of birth (I-9)
[prefilled]
__yes __no
8. SSN (I-9)
[prefilled]
__yes __no
9. Alien/Admission # (I-9)
[prefilled]
__yes __no
10. Citizenship (I-9)
[prefilled]
__yes __no
11. Hire date (I-9)
[prefilled]
__yes __no
12. Verification initiated date (system print-
out)
[prefilled]
__yes __no
13. Date of employee signature on I-9
14. Date of employer signature on I-9
`
15. Tentative