Please enter the email address of the Employer or Authorized Representative who will be completing Section 2 of this form. Upon submission, the form will be routed to the Employer email entered for the Employer to complete.
If you are unsure of which email to enter, please click "Save & Finish Later" at the bottom of the form. Then, gather the correct info and then resume the form.
IMPORTANT NOTE: The Employee will need to provide their acceptable document(s) to the Employer or Authorized Representative for verfication.
The Employee and Employer are responsible for coordinating the review of the acceptable document(s).
Once the acceptable document(s) have been reviewed, the Employer will be responsible for uploading a copy of the acceptable document(s) when they sign the form.