Employment Eligibility Verification Department of Homeland ...

Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

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.

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.)

Last Name (Family Name)

First Name (Given Name)

Middle Initial Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number City or Town

State ZIP Code

Date of Birth (mm/dd/yyyy)

U.S. Social Security Number

-

-

Employee's E-mail Address

Employee's Telephone Number

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):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions)

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.

QR Code - Section 1 Do Not Write In This Space

1. Alien Registration Number/USCIS Number:

OR

2. Form I-94 Admission Number:

OR

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee

Today's Date (mm/dd/yyyy)

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.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator

Today's Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Address (Street Number and Name)

City or Town

State ZIP Code

Form I-9 07/17/17 N

Employer Completes Next Page

Page 1 of 3

Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

Section 2. Employer or Authorized Representative Review and Verification

(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.")

Last Name (Family Name) Employee Info from Section 1

First Name (Given Name)

M.I. Citizenship/Immigration Status

List A Identity and Employment Authorization

Document Title

OR Document Title

List B Identity

AND

List C Employment Authorization

Document Title

Issuing Authority

Issuing Authority

Issuing Authority

Document Number

Document Number

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Expiration Date (if any)(mm/dd/yyyy)

Expiration Date (if any)(mm/dd/yyyy)

Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy)

Additional Information

QR Code - Sections 2 & 3 Do Not Write In This Space

Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy)

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.

The employee's first day of employment (mm/dd/yyyy):

(See instructions for exemptions)

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name The University of Akron

Employer's Business or Organization Address (Street Number and Name) City or Town

185 E. Mill Street

Akron

State OH

ZIP Code 44325

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

B. Date of Rehire (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Document Title

Document Number

Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Form I-9 07/17/17 N

Page 2 of 3

LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A

Documents that Establish Both Identity and

Employment Authorization OR

LIST B

Documents that Establish Identity

AND

LIST C

Documents that Establish Employment Authorization

1. U.S. Passport or U.S. Passport Card

2. 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 machinereadable immigrant visa

4. 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:

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 RMI

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 address

2. 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 address

3. School ID card with a photograph

4. Voter's registration card

5. U.S. Military card or draft record

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner Card

8. Native American tribal document

9. Driver's license issued by a Canadian government authority

1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT

(2) VALID FORWORK ONLYWITH INS AUTHORIZATION

(3) VALID FORWORK ONLYWITH DHS AUTHORIZATION

2. 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 seal

4. Native American tribal document

5. U.S. Citizen ID Card (Form I-197)

6. Identification Card for Use of Resident Citizen in the United States (Form I-179)

For persons under age 18 who are unable to present a document listed above:

7. Employment authorization document issued by the Department of Homeland Security

10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record

Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form I-9 07/17/17 N

Page 3 of 3

The University of Akron Human Resources (+4704) (330)972-7096 Fax (330)972-5195

TO:

All University of Akron Faculty, Contract Professionals, and Staff

FROM : Human Resources

SUBJECT: Ohio Ethics Law

The State of Ohio Ethics Law establishes standards of ethical conduct for public officials and employees. As an employee of The University of Akron, you are covered by the provisions of this legislation, which includes Chapters 102 and 2921 of the Ohio Revised Code.

Chapter 102 is commonly referred to as the Ethics Bill, and it establishes certain criminal ethical prohibitions and enforcement procedures that apply to all public officials and employees. Chapter 2921 is a portion of the Ohio Criminal Code and it codifies crimes involving offenses against justice and public administration.

The University is required as a public agency to provide employees and public officials a copy of these chapters. Please review these laws at and be aware of their applicability to you. Failure to comply with them could result in criminal penalties.

Section 102.09 requires written acknowledgement within 15 days of receipt of this law. Please sign below and return this letter to Human Resources (+4730).

I acknowledge receipt of the link to Chapter 102 (Sections 102.01 to 102.99 inclusive) and Chapter 2921 of the Ohio Revised Code on The Ohio Ethics Commission website.

NAME:

_ DEPARTMENT:

_

(print)

SIGNATURE:

DATE:

HRF008 Revised 01/2017

TO:

All University of Akron Faculty, Contract Professionals, and Staff

FROM:

The Human Resources Department

SUBJECT: Sexual Harassment Policy (University Rule 3359-11-13)

The attached University of Akron Sexual Harassment Policy reaffirms the University's commitment to an academic, work, and study environment free of inappropriate and disrespectful conduct and communication in any form and of any kind. As an employee of The University of Akron, you are covered by the provisions of University of Akron Rule 3359-11-13.

The University of Akron is providing you with a copy of the Sexual Harassment Policy which includes the definition of sexual harassment and the responsibilities of all persons affiliated with the University. The Policy also outlines the investigative and complaint procedures.

Please review the attached Policy and be aware of its applicability to you. Failure to comply with the Sexual Harassment Policy could result in disciplinary action, up to and including termination.

Please sign this acknowledgement form and return it to the Human Resources Department front desk.

I acknowledge receipt of The University of Akron's Sexual Harassment Policy (University Rule 3359-11-13).

NAME:

(print)

DEPARTMENT:

SIGNATURE:

DATE:

HRF040 Sexual Harassment Policy Acknowledgement Form 07/2016

Human Resources Administrative Services Building

Akron, OH 44325

The University of Akron is an Equal Education and Employment Institution

3359-11-13 Sexual harassment policy.

(A) Statement of policy.

(1) The university of Akron reaffirms its commitment to an academic, work, and study environment free of inappropriate and disrespectful conduct and communication in any form. All students, faculty, and staff shall be protected under the guidelines of this policy.

(2) A copy of this policy shall be incorporated into all employee handbooks. It shall also be included in student orientation materials, including those distributed to students in professional schools. It shall also be published in scheduling materials each semester. Copies of this policy shall be available at appropriate university offices, including the office of the deans of each college, the university library, associate vice president for student affairs, the affirmative action office, the department of human resources, all other administrative offices, and other places specified by the executive director of human resources.

(3) It shall be the policy of the university of Akron to prohibit any and all forms of sexual harassment. All students, faculty, and staff have a responsibility to assist in the enforcement of this policy, be aware of its contents, and to abide by its terms. All supervisory personnel shall insure that those who are under their supervision are aware of the policy, receive a copy of it, and shall from time to time reinforce the university's commitment to the policy. From time to time, the affirmative action office shall disseminate materials throughout the university concerning the effective prevention of sexual harassment.

(4) By this policy, the university is providing notice that sexual harassment in any form will not be tolerated and that the procedures specified below shall be utilized to inform the university of incidents of harassment and to allow all students, faculty, and staff to prevent, report, and to eliminate sexual harassment from this campus.

(B) Definitions. Sexual harassment is a form of sex discrimination which violates state and federal laws respecting both employees and students. The definitions used in this policy shall be interpreted consistent with such laws.

(1) It consists of unwelcome sexual advances, requests for sexual favors, sexually motivated physical conduct, or other verbal or physical conduct or communication of a sexual nature when:

3359-11-13

2

(a) Submission to that conduct or communication is made a term or condition, either explicitly or implicitly, of obtaining or retaining employment, of obtaining an education, or of obtaining educational benefits or opportunities; or

(b) Submission to or rejection of that conduct or communication by an individual is used as a factor in decisions affecting that individual's employment, education, educational benefits or opportunities; or

(c) Such conduct or communication has the purpose or effect of substantially or unreasonably interfering with an individual's employment, education, educational benefits or opportunities, or creating an intimidating, hostile or offensive employment or education environment. Any sexual harassment as defined herein is limited to conduct or communication by someone in authority, but also includes any sexual harassment as defined herein when perpetrated on any student or employee by any other student or employee.

(2) Sexual harassment is sexual conduct that is "unwelcome." It may include, but is not limited to:

(a) Uninvited verbal harassment or abuse such as sexual name calling, jokes, spreading sexual rumors, leers, or overly personal conversations of a sexual nature;

(b) Subtle pressure for sexual activity;

(c) Inappropriate patting, pinching or fondling, pulling at clothes, or intentional brushing against a student's or an employee's body;

(d) Demanding sexual favors accompanied by implied or overt threats concerning an individual's employment or educational status;

(e) Demanding sexual favors accompanied by implied or overt promises of preferential treatment with regard to an individual's employment or educational status;

(f) Any sexually motivated unwelcome touching, cornering, or blocking an individual's movement;

(g) Conditioning a student's grade or academic progress on submission to sexual activity;

(h) Hanging or displaying inappropriate and sexually explicit pictures,

3359-11-13

3

posters, or drawings in the workplace;

(i) A pattern of conduct intended to discomfort or humiliate, or both, a reasonable person at whom the conduct was directed that includes one or more of the following: unnecessary touching or hugging, remarks of a sexual nature about a person's clothing or body, or remarks about sexual activity or speculations about previous sexual experience.

(3) The university recognizes that not every advance or consent of a sexual nature constitutes harassment. Whether a particular action or incident is a personal social relationship without a discriminatory effect requires a determination based on all the facts and surrounding circumstances. False accusations of sexual harassment can have a serious detrimental effect on innocent parties and all others who are concerned. This policy shall not be used to bring frivolous or malicious charges against fellow students, faculty members, or employees. Such charges may result in discipline against the offending individual pursuant to applicable university disciplinary procedures.

(C) Retaliation. Under this policy, retaliation is defined as the undertaking of adverse action against students or employees for the exercise of rights under this policy; or for having brought forward a charge of discrimination or sexual harassment, testified, assisted, or participated in any manner in an investigation or hearing or other proceeding under this policy or pursuant to procedures provided by law. The exercise of such legally protected rights shall not reflect upon an individual's status or affect future employment, grades, or assignments when such exercise is pursuant to the terms set forth in this policy.

(D) Responsibility.

(1) All persons affiliated with the university have a responsibility to actively oversee and implement this policy. The affirmative action officer shall facilitate and administer this policy consistent with the terms set forth herein and consistent with the state and federal rules, regulations, and laws governing this institution.

(2) Any person who believes he or she has been the victim of sexual harassment by an employee, student, or visitor of the university, or any third person with knowledge or belief of such conduct, should report the alleged acts immediately to a university official listed in paragraph (e) of this rule.

(3) Employees and students should make clear through affirmative conduct and/or verbal statements to an alleged harasser that such conduct is unwelcome and uninvited and should cease immediately. However, the employee's or

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