Employee form
Rafael Ortiz
CompleteI-9 employment eligibility
I-9 employment eligibility
This intake record does not replace the official W-4 or I-9. Complete the original in your employer's designated system; your manager must verify it before this task can finish.
- Section 1 signed on
- 2022-06-06
- Citizenship or immigration status on your I-9
- Lawful permanent resident
- Work authorization expires
- —
- My work authorization has no expiration date
- No
Manager verification
- Documents examined
- One List A document (passport, permanent resident card)
- Document titles
- Permanent resident card (Form I-551)
- Section 2 completed on
- 2022-06-07
- Examined by
- Maria Reyes
- Original form record reference
- I-9 binder, Castle Rock office, locked cabinet: Ortiz, Rafael
- I verified the completed official form in our designated records system
- Yes
Submission history
- Sept. 21, 2026, 11:55 a.m. · dana.whitfield@frontrange-roofing.example Sept. 21, 2026, 11:55 a.m. · dana.whitfield@frontrange-roofing.example · Approved Download submitted copy