En Español
After December 31, 2007, the following employer hired one or more undocumented alien workers as employees and/or independent contractors:
After December 31, 2007, the following person was hired as an employee or independent contractor by the employer named on the first page and at the time of hiring, the following person was not authorized to work in the United States:
I hereby affirm that the information set forth on all the pages of this form is true and correct.