FORM I-9

Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
OMB No. 1615-0047
Expires 08/31/2019

► START HERE:Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE:It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which
document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ
an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation
(Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

OR

OR

Preparer and/or Translator Certification (check one):

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

Employer Completes Next Page

Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
OMB No. 1615-0047
Expires 08/31/2019

Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists
of Acceptable Documents.")

List A
Identity and Employment Authorization

OR

List B
Identity

AND

List C
Employment Authorization

Certification : I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,
(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.

(See instructions for exemptions)

Section 3. Reverification and Rehires(To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

B. Date of Rehire (if applicable)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes
continuing employment authorization in the space provided below.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED

Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.

LIST A
Documents that Establish
Both Identity and
Employment Authorization

1. U.S. Passport or U.S. Passport Card

2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)

3. Foreign passport that contains a
temporary I-551 stamp or temporary
I-551 printed notation on a machine-
readable immigrant visa

4. Employment Authorization Document
that contains a photograph (Form
I-766)

5. For a nonimmigrant alien authorized
to work for a specific employer
because of his or her status:
a. Foreign passport; and
b. Form I-94 or Form I-94A that has the following:

6.Passport from the Federated States of
Micronesia (FSM) or the Republic of
the Marshall Islands (RMI) with Form
I-94 or Form I-94A indicating
nonimmigrant admission under the
Compact of Free Association Between
the United States and the FSM or RMI

LIST B
Documents that Establish
Identity

1. Driver's license or ID card issued by a
State or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height, eye
color, and address

2. ID card issued by federal, state or local
government agencies or entities,
provided it contains a photograph or
information such as name, date of birth,
gender, height, eye color, and address

3. School ID card with a photograph

4. Voter's registration card

5. U.S. Military card or draft record

6.Military dependent's ID card

7.U.S. Coast Guard Merchant Mariner
Card

8.Driver's license issued by a Canadian
government authority

9.Driver's license issued by a Canadian
government authority

For persons under age 18 who are
unable to present a document
listed above:

10.School record or report card

11.Clinic, doctor, or hospital record

12.Day-care or nursery school record

LIST C
Documents that Establish
Employment Authorization

1.A Social Security Account Number
card, unless the card includes one of
the following restrictions:

2. Certification of Birth Abroad issued
by the Department of State (Form
FS-545)

3. Certification of Report of Birth
issued by the Department of State
(Form DS-1350)

4. Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal

5.Native American tribal document

6.U.S. Citizen ID Card (Form I-197)

7.Identification Card for Use of
Resident Citizen in the United
States (Form I-179)

8.Employment authorization
document issued by the
Department of Homeland Security

Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Corporate Office

Brea

60 Pointe Dr. #100 Brea, CA 92821

West Covina

549 S. California Ave West Covina, CA 91790

Lynwood

10919 Atlantic Ave Lynwood, CA 90262

Lancaster

2155 W. Longhorn Drive Lancaster, Tx 75134

Whittier

14714 Whittier Blvd Whittier, CA 90603

Ontario

1035 S. Millken Ave Suite A Ontario, CA 91761

Carson

860 E. Carson St #114 Carson, CA 90745