Temporary Fill-Ins North / South

Dental Staffing with a Personal Touch™

 

 

Form

I-9

U.S. Department of Homeland Security

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):
Type X to select
Type X to select
Type X to select
Type X to select