Battle Creek Employee

I-* Electronic Receipt

Electronic Signature Receipt # :

Employee :

Form I-9 Section 1 : (employee)

Albert Harkins

UZGZ-8062-UZUZ-7849

I-9 Code : EB-90954

Company Name :

Company Identifier :

Employbridge

CST1256

Address : 36 Eldridge Street,, Battle Creek, Michigan, 49037 SSN :

Date of Birth : 03/29/1981

Certification

Signature of Employee :

Time (Employee) : 12/23/2023 1:08:14 AM

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): Citizen of US Initial : AH

IP Address : 172.58.120.27

Albert Harkins - esign

Company EIN :

USCIS or A-Number : N/A

Time : N/A

Translator : N/A

Translator Address : N/A

Signature of Translator : N/A

Translator Initial : N/A

Translator IP Address : N/A

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