TLJ Employee Document Signing

Pay Type Hourly Salary Hourly Rate($) Salary(Bi-Weekly $) Manager / Witness Manager Signature Text

Citizenship / Immigration Status U.S. citizen Noncitizen national of the U.S. Lawful permanent resident Alien authorized to work USCIS / A-Number Work Auth Expiration I-94 Number Passport / Country

First Day Employed Employer Rep Name/Title Employer Signature Text Employer Signed Date Business Name Business Address List B Document Title List B Issuing Authority List B Document Number List B Expiration List C Document Title List C Issuing Authority List C Document Number List C Expiration Additional Information

Bank Name Routing Number Account Number Account Type Checking Savings