unstructuredio/SCORE-Bench · Datasets at Hugging Face

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Payee: Japan Medical Research Institute Co.,Ltd
Please pay no later than 28ᵗʰ September 2018
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Source: https://www.industrydocuments.ucsf.edu/docs/hqcv0284
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U.S. DEPARTMENT OF HOMELAND SECURITY
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Employment Eligibility Verification
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Department of Homeland Security
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U.S. Citizenship and Immigration Services
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USCIS Form I-9
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OMB No.1615-0047 Expires 07/31/2026
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START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.
ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.
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.
Last Name (Family Name) ___
First Name (Given Name) ___
Middle Initial (if any) ___
Other Last Names Used (if any) ___
Address (Street Number and Name) ___
Apt. Number (if any) ___
City or Town ___
State ___
ZIP Code ___
Date of Birth (mm/dd/yyyy) ___
U.S. Social Security Number _ _ _ _ _ _ _ _ _
Employee's Email Address ___
Employee's Telephone Number ___
I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.
Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.):
[] 1. A citizen of the United States
[] 2. A noncitizen national of the United States (See Instructions.)
[] 3. A lawful permanent resident (Enter USCIS or A-Number.) ___
[] 4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any) ___
If you check Item Number 4., enter one of these:
USCIS A-Number ___
OR
Form I-94 Admission Number ___
OR
Foreign Passport Number and Country of Issuance ___
Signature of Employee ___
Today's Date (mm/dd/yyyy) ___
If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.
Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.
List A OR List B AND List C
Document Title 1
Issuing Authority
Document Number (if any)
Expiration Date (if any)
Document Title 2 (if any) Additional Information
Issuing Authority
Document Number (if any)
Expiration Date (if any)
Document Title 3 (if any)
Issuing Authority
Document Number (if any)
Expiration Date (if any)
[] Check here if you used an alternative procedure authorized by DHS to examine documents.
Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears 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.
First Day of Employment (mm/dd/yyyy): ___
Last Name, First Name and Title of Employer or Authorized Representative ___
Signature of Employer or Authorized Representative ___
Today's Date (mm/dd/yyyy) ___
Employer's Business or Organization Name ___
Employer's Business or Organization Address, City or Town, State, ZIP Code ___
For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.
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Form I-9 Edition 08/01/23
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Page 1 of 4
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Payee: Japan Medical Research Institute Co.,Ltd

Please pay no later than 28ᵗʰ September 2018

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Source: https://www.industrydocuments.ucsf.edu/docs/hqcv0284

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--------------------------------------------------- Unstructured Plain Text Format 1.0.0

--------------------------------------------------- Unstructured Page Header Begin

--------------------------------------------------- Unstructured Image Begin

U.S. DEPARTMENT OF HOMELAND SECURITY

--------------------------------------------------- Unstructured Image End

--------------------------------------------------- Unstructured Title Begin

Employment Eligibility Verification

--------------------------------------------------- Unstructured Title End

--------------------------------------------------- Unstructured Sub-Title Begin

Department of Homeland Security

--------------------------------------------------- Unstructured Sub-Title End

U.S. Citizenship and Immigration Services

--------------------------------------------------- Unstructured Sub-Title Begin

USCIS Form I-9

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OMB No.1615-0047 Expires 07/31/2026

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--------------------------------------------------- Unstructured Form Begin

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.

ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.

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.

Last Name (Family Name) ___

First Name (Given Name) ___

Middle Initial (if any) ___

Other Last Names Used (if any) ___

Address (Street Number and Name) ___

Apt. Number (if any) ___

City or Town ___

State ___

ZIP Code ___

Date of Birth (mm/dd/yyyy) ___

U.S. Social Security Number _ _ _ _ _ _ _ _ _

Employee's Email Address ___

Employee's Telephone Number ___

I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.):

[] 1. A citizen of the United States

[] 2. A noncitizen national of the United States (See Instructions.)

[] 3. A lawful permanent resident (Enter USCIS or A-Number.) ___

[] 4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any) ___

If you check Item Number 4., enter one of these:

USCIS A-Number ___

OR

Form I-94 Admission Number ___

OR

Foreign Passport Number and Country of Issuance ___

Signature of Employee ___

Today's Date (mm/dd/yyyy) ___

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.

Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.

List A OR List B AND List C

Document Title 1

Issuing Authority

Document Number (if any)

Expiration Date (if any)

Document Title 2 (if any) Additional Information

Issuing Authority

Document Number (if any)

Expiration Date (if any)

Document Title 3 (if any)

Issuing Authority

Document Number (if any)

Expiration Date (if any)

[] Check here if you used an alternative procedure authorized by DHS to examine documents.

Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears 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.

First Day of Employment (mm/dd/yyyy): ___

Last Name, First Name and Title of Employer or Authorized Representative ___

Signature of Employer or Authorized Representative ___

Today's Date (mm/dd/yyyy) ___

Employer's Business or Organization Name ___

Employer's Business or Organization Address, City or Town, State, ZIP Code ___

For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.

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Form I-9 Edition 08/01/23

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Page 1 of 4

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