Employment Application - I9, W4 Combined Form

Choose Language

Spanish

English

Enter the following information

Name*

Last Name*

Enter the following information

Email*

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Address*

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Phone*

Enter the following information

Date of Birth*

Enter the following information

Social Security Number*

Claim Dependents

What is the number of qualifying children under age 17?*

What is the number of other dependents?*

I attest, under penalty of perjury, that i am (check one of the following boxes)*

A citizen of the United States

A non-citizen national of the United States

A legal permanent resident.

A foreigner authorized to work until

Expiration date*

Alien Registration Number/USCIS Number

OR

Form I-94 Admission Number

OR

Foreign Passport Number

Country of Issuance

Check one of the following boxes

Single or married filing a separate return

Married Filing Jointly or Qualifying Widowed

Head of Household (Check only if you are not married and pay more than half the cost of keeping up a home for yourself and a qualifying person).

Where did you hear about us?

Social Media

An employee of Diaz Group LLC

Through the website.

I saw the ad on the street

None of the above

Emergency Contacts

Emergency contact name*

Emergency contact phone

Emergency contact relationship*

Which ID would you like to send us?

Passport

Permanent Resident

Consular ID card and SSN

Drivers license and SSN

Add a photo of your passport

Supports JPG, PNG, SVG

Sample Passport

Please select the checkbox

By signing below, I hereby acknowledge that I have completely read and fully understand the The Diaz Group Policy Guidelines. I also affirm the truth of the statements:

Choose Language

Enter the following information

Enter the following information

Enter the following information

Enter the following information

Enter the following information

Enter the following information

Claim Dependents

I attest, under penalty of perjury, that i am (check one of the following boxes)*

OR

OR

Check one of the following boxes

Where did you hear about us?

Emergency Contacts

Which ID would you like to send us?

Add a photo of your passport

Add a photo of your passport

Add a photo of your permanent resident card

Add a photo of your permanent resident card

Add consular and social security card photos

Add drivers license and social security card photos

Add consular card photo

Add drivers license photo

Add social security card photo

Please select the checkbox

Please add your signature