ESR E-Verify Account Setup Worksheet

In order to establish and activate your company in the USCIS/DHS E-Verify program, please complete this worksheet in its entirety. If you have questions or need help, please contact your Client Service Representative.

Once we register this information with USCIS/DHS, your CSR will send you a Memorandum of Understanding (MOU) which must be signed and returned. Among other things, this memorandum certifiesyour Designated Agent for E-Verify. An E-VERIFY worksheet is required for each 'EIN'.

PART ONE: Organization / Company Designation

Please identify whether your company is part of the Federal Government, State Government, Local Government or a Federal Contractor. If your company does not fall within any of these categories, please select "None of these categories apply."

Type of Organization. Select answer from dropdown (Required) *

If you indicated that you are a Federal Contractor. Select answer from dropdown (Required) *

PART TWO: Employer Company Information

Please provide your Dun and Bradstreet Number (DUNS). *

Company Name as it appears on your legal documents. *

Corporate Office Physical Address

Street Address *

Address Line 2

City *

State *

Zip Code *

County or Parish *

Corporate Mailing Address (if different from above):

Address Line 2

Street Address *

City *

State *

Zip Code *

County or Parish *

Employer Identification Number: *

If you already have an i-9 E-verification account for this FEIN, please list it:

North American Industry Classification Systems Code.
If you do not know your NAICS code number, their website is as follows: http://www.census.gov/eos/www/naics/ *

Parent Company: *

Number of Employees: *

Client Contact:
Please list the person at your company that would the appropriate contact if the government should need to contact you if they have a question, or discuss the use of E-Verify at your site.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Fax Number

Email Address *

Do you have multiple locations for this EIN? *

Yes

No

Do you have multiple locations for this EIN? *

Yes

No

	Number of hiring locations in each state
Alabama	Number of hiring locations in each state
Alaska	Number of hiring locations in each state
Arizona	Number of hiring locations in each state
Arkansas	Number of hiring locations in each state
California	Number of hiring locations in each state
Colorado	Number of hiring locations in each state
Connecticut	Number of hiring locations in each state
Delaware	Number of hiring locations in each state
District of Columbia	Number of hiring locations in each state
Florida	Number of hiring locations in each state
Georgia	Number of hiring locations in each state
Hawaii	Number of hiring locations in each state
Idaho	Number of hiring locations in each state
Illinois	Number of hiring locations in each state
Indiana	Number of hiring locations in each state
Iowa	Number of hiring locations in each state
Kansas	Number of hiring locations in each state
Kentucky	Number of hiring locations in each state
Louisiana	Number of hiring locations in each state
Maine	Number of hiring locations in each state
Maryland	Number of hiring locations in each state
Massachusetts	Number of hiring locations in each state
Michigan	Number of hiring locations in each state
Minnesota	Number of hiring locations in each state
Mississippi	Number of hiring locations in each state
Missouri	Number of hiring locations in each state
Montana	Number of hiring locations in each state
Nebraska	Number of hiring locations in each state
Nevada	Number of hiring locations in each state
New Hampshire	Number of hiring locations in each state
New Jersey	Number of hiring locations in each state
New Mexico	Number of hiring locations in each state
New York	Number of hiring locations in each state
North Carolina	Number of hiring locations in each state
North Dakota	Number of hiring locations in each state
Ohio	Number of hiring locations in each state
Oklahoma	Number of hiring locations in each state
Oregon	Number of hiring locations in each state
Pennsylvania	Number of hiring locations in each state
Puerto Rico	Number of hiring locations in each state
Rhode Island	Number of hiring locations in each state
South Carolina	Number of hiring locations in each state
South Dakota	Number of hiring locations in each state
Tennessee	Number of hiring locations in each state
Texas	Number of hiring locations in each state
Utah	Number of hiring locations in each state
Vermont	Number of hiring locations in each state
Virginia	Number of hiring locations in each state
Virgin Islands	Number of hiring locations in each state
Washington	Number of hiring locations in each state