USA MEDICAL IMAGING

Form I-9

Section 1. Employee Information and Attestation (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.)

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 boxes):

Preparer and/or Translator Certification (check one):

Section 2. Employer or Authorized Representative Review and Verification

List A - Identity and Employment Authorization

Document Title Issuing Authority Document Number Degree Received Expiration Date

List B - Identity

List C - Employment Authorization

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

Section 3. Re-verification and Re-hires(To be completed and signed by employer or authorized representative.)

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