Customer Relations Service, material handler, warehouse

I-* Electronic Receipt

Electronic Signature Receipt # :

Employee :

Form I-9 Section 1 : (employee)

Roosevelt Moore

HGTA-3499-HGHG-2784

I-9 Code : I9-161897

Company Name :

Company Identifier :

Pepsico, Inc

CST1026

Address : 420 Ansonville Lane,, Modesto, California, 95357 SSN : XXX - XX - 6048

Date of Birth : 12/13/1986

Certification

Signature of Employee :

Time (Employee) : 10/12/2024 12:00:00 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 : RM

IP Address : 23.122.228.162

Roosevelt Moore - 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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