Forklift operator

December ****

WORKFORCE INNOVATION AND OPPORTUNITY ACT

AUTHORIZATION TO WORK - CHECKLIST

Copies of the appropriate documents must be maintained in the customer’s official record. For individuals to participate in Workforce Innovation and Opportunity Act programs, they must be authorized to work in the United States. Please complete the following form, choosing one item from List A, or one item from List B and one item from List C.

Print Name: Last First MI Maiden Name

Date of Birth (month/day/year)

Social Security Number

All documents must be unexpired

LIST A LIST B LIST C

Documents That Establish Both

Identity and Employment Eligibility

Documents That Establish Identity Documents That Establish Employment Eligibility

OR AND

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

Permanent Resident Card or Alien

Registration Receipt Card (Form I-551)

Foreign Passport, that contains a temporary

I-551 stamp or temporary I-551 printed

notation on a machine-readable immigration

visa

Employment Authorization Document that

contains a Photograph (Form I-766)

In the case of a nonimmigrant alien

authorized to work for a specific employer

incident to status, a foreign passport with

Form I-94 or Form I-94A bearing the same

name as the passport and containing an

endorsement of the alien’s nonimmigrant

status, as long as the period of endorsement

has not yet expired and the proposed

employment is not in conflict with any

restrictions or limitations identified on the

form

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

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

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

School ID Card with a photograph

Voter’s Registration Card

U.S. Military Card or Draft Record

Military Dependent’s ID Card

U.S. Coast Guard Merchant Mariner Card

Native American Tribal Document

Driver’s License issued by a Canadian

government authority

For persons under age 18 who are unable to

present a document listed above:

School record or report card

Clinic, doctor, or hospital record

Day care or nursery school record

Social Security Account Number card other

than one that specifies on the face that the

issuance of the card does not authorize

employment in the United States

Certificate of Birth Abroad issued by the

Department of Homeland Security (Forms

FS-545 or FS-240)

Certification of Report of Birth issued by

the Department of Homeland Security

(Form DS-1350)

Original or certified copy of a birth

certificate issued by a State, county,

municipal authority or territory of the

United States bearing an official seal

Native American Tribal Document

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

Identification Card for use of Resident

Citizen in the United States (Form I-179)

A letter of certification issued by the

Department of Health and Human Services

(Human Trafficking)

Employment authorization document

issued by the Department of Homeland

Security

Screenprint of UI screen Current Claim

Status

UI award letter

Expedited Eligibility through TAA

Expedited Eligibility for RESEA customers

outreached within the last 10 weeks

Workforce Solutions Staff Signature Print Name Date

Contact this candidate