Employee Record Review Form - Uscis Page 2
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1
2
3Employee Record Review Form ([
]/[
])
prefilled name
prefilled SS#
Case #: _____[CASE_NBR]___
3.
Does (2) match the
2.
4.
Information from
employee's record
Information from
1.
5.
Items To Be Reviewed
Transaction Database
file?
Employee's Record
Comments
6.
Name (I-9)
Last
__yes
__no
First
__yes
__no
[prefilled]
Middle Initial
__yes
__no
7.
Date of birth (I-9)
__yes
__no
[prefilled]
8.
SSN (I-9)
__yes
__no
[prefilled]
9.
Alien/Admission # (I-9)
__yes
__no
[prefilled]
10.
Citizenship (I-9)
__yes
__no
[prefilled]
11.
Hire date (I-9)
__yes
__no
[prefilled]
12.
Verification initiated date (system print-
out)
__yes
__no
[prefilled]
13.
Date of employee signature on I-9
14.
Date of employer signature on I-9
`
15.
Tentative nonconfirmation issued
[prefilled]
(system print-out/TNC notice)
__yes
__no
16.
Date of employee signature on TNC
17.
Date of employer signature on TNC
18.
Contested with SSA (TNC notice)?
[prefilled]
__yes
__no
19.
Contested with DHS (TNC notice)?
__yes
__no
[prefilled]
20.
Date referred to SSA (Referral letter)
__yes
__no
[prefilled]
21.
Date SSA signed referral letter
(Employee went to SSA)
22.
Date resubmitted to SSA
__yes
__no
[prefilled]
23.
Date referred to DHS (DHS referral
letter)
__yes
__no
[prefilled]
24.
Employee contacted DHS?
[
[prefilled]
__yes
__no
25.
Closure reason (system printout)
__yes
__no
[prefilled]
26.
Closure date
__yes
__no
[prefilled]
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