Federal I-9 This field is hidden when viewing the formWho is this from? Windstar Lines Safety System Employer's Name and Address* Windstar Lines Inc, 1903 North US Hwy 71, Carroll, IA 51404, Phone 888-494-6378, Fax: 712-792-9615 This field is hidden when viewing the formEmployer identification number (EIN) 27-1577755 W4 line 10I9 PreparationThis form will help you complete the required documentation for employment. This form will complete the I9 documents for your signature. If you prefer to do it in paper, feel free to contact your employer for assistance. Which location are you based in?* Carroll, Iowa Cedar Rapids, Iowa Des Moines, IA Dubuque, IA Kansas City, MO Las Vegas, NV Lincoln, Nebraska Orlando, FL Phoenix, AZ Roxana, IL Rockford, IL Sioux Falls, SD Your Name* (Given Name) Middle Initial (Family Name) Have you ever used another last name?* Yes No Logic field shows Last Name Used if selected yesOther Last Names Used (if any) Other Last Names Used (if any) Home Address* Home Address Apartment or Unit City State / Province / Region ZIP / Postal Code Number and street or rural route, apt. number or unit numberU.S. Social Security Number*W4 line 2Date of Birth (mm/dd/yyy)* MM slash DD slash YYYY Email* Enter Email Confirm Email PhoneI9 Section ONE(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.) USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019You will be required to upload an image of the documents you identify shortly. You need to have an image of the documents to upload. You need to make sure you have a clear and properly focused image to upload, and you will need to bring in the originals of the documentation your first date of employment.* I have the required document images to upload I do not have the required documents, I will use the "save and continue" button below, email myself the link as directed, and then take the images of the documents I need to upload. ANTI-DISCRIMINATION NOTICE:* It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. I attest, under penalty of perjury, that I am (check one of the following): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident 4. An alien authorized to work until (See instructions) What number would you like to provide?* Alien Registration Number/USCIS Number: Form I-94 Admission Number: Foreign Passport Number Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. Expiration date, if applicable, mm/dd/yyyy: MM slash DD slash YYYY Some aliens may write "N/A" in the expiration date field. (See Instructions)Alien Registration Number*FORM I-94 Admission Number*Foreign Passport Number*Country of Issuance*Signature of Employee*Preparer and/or Translator Certification (check one):* I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) TranslatorName* Given Name Family Name Today's Date* MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code Signature of Translator*I9 Section TWO(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") This field is hidden when viewing the formWhat are you doing? New Hire Re-verification or Rehire Employee Information from Section 1* (Given Name) Middle Initial (Family Name) Citizenship or Immigration Status 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident 4. An alien authorized to work until (See instructions) Will you be providing: One document from LIST A Two documents, one each from LIST B and C List A, Documents that Establish Both Identity and Employment AuthorizationList A Document Title*1. U.S. Passport or U.S. Passport Card2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa4. Employment Authorization Document that contains a photograph (Form I-766)5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status: Documents that Establish Both Identity and Employment Authorization a. Foreign passport; and b. Form I-94 or Form I-94A that has the following: (1) The same name as the passport; and (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.6. 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 RMIList A Issuing Authority* USA Canada Mexico List A Document Number*List A Expiration Date (if any)(mm/dd/yyyy)* MM slash DD slash YYYY List A Upload Document Drop files here or Select files Max. file size: 370 MB. List B, Documents that Establish IdentityList B Document Title*1. 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 address2. 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 address3. School ID card with a photograph4. Voter's registration card5. U.S. Military card or draft record6. Military dependent's ID card7. U.S. Coast Guard Merchant Mariner Card8. Native American tribal document9. Driver's license issued by a Canadian government authorityUnder 18 years old: 10. School record or report cardUnder 18 years old: 11. Clinic, doctor, or hospital recordUnder 18 years old: 12. Day-care or nursery school recordList B Issuing Authority* State School Military Tribe Canada List B Document Number*List B Expiration Date (if any)(mm/dd/yyyy)* MM slash DD slash YYYY Enter 01/01/2000 if your document has no expiration such as a Social Security card or similarList B Upload Document Drop files here or Select files Max. file size: 370 MB. List C, Documents that Establish Employment AuthorizationList C Document Title*1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal4. Native American tribal document5. U.S. Citizen ID Card (Form I-197)6. Identification Card for Use of Resident Citizen in the United States (Form I-179)7. Employment authorization document issued by the Department of Homeland SecurityList C Document Number*List C Issuing Authority* USA Canada Mexico List C Expiration Date (if any)(mm/dd/yyyy)* MM slash DD slash YYYY Enter 01/01/2000 if your document has no expiration such as a Social Security card or similarList C Upload Document Drop files here or Select files Max. file size: 370 MB.
