PURSUANT TO DEPARTMENT OF HOMELAND SECURITY, U.S. CITIZENSHIP AND IMMIGRATION SERVICES, AND/OR THE LAWS, RULES, AND REGULATIONS OF THE UNITED STATES, FEDERAL, STATE, CITY AND COUNTIES, IT IS MANDATORY THAT THE FOLLOWING INFORMATION BE PROVIDED BY YOU FOR ANY EMPLOYMENT IN THE UNITED STATES.

Please note that facsimile, photocopy, scanned and email signatures will be accepted as originals.

I understand that the submission of my application shall serve as an acknowledgment by me that the Company may have: (i) the Social Security Administration confirm the accuracy of the social security number provided by me, and the employment authorization of U.S. citizens, and (ii) access to selected data from the Department of Homeland Security database to enable the Company to conduct (a) automated verification checks by electronic means, and (b) photographic verification checks.

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