{"id":397,"date":"2018-06-20T03:37:32","date_gmt":"2018-06-20T03:37:32","guid":{"rendered":"http:\/\/bcshowies.com\/?page_id=397"},"modified":"2018-06-20T03:41:35","modified_gmt":"2018-06-20T03:41:35","slug":"w4-i9","status":"publish","type":"page","link":"https:\/\/bcshowies.com\/index.php\/w4-i9\/","title":{"rendered":"I-9 &#038; W-4"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.0.69&#8243; background_image=&#8221;http:\/\/bcshowies.com\/wp-content\/uploads\/2017\/08\/yellowbackgroudletter.jpg&#8221;][et_pb_row _builder_version=&#8221;3.0.48&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.0.47&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221;][et_pb_image src=&#8221;http:\/\/bcshowies.com\/wp-content\/uploads\/2017\/08\/HH_logohorizontal_4color.png&#8221; align=&#8221;center&#8221; _builder_version=&#8221;3.0.87&#8243; max_width=&#8221;50%&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;on|phone&#8221; animation_style=&#8221;slide&#8221; animation_direction=&#8221;left&#8221; animation_duration=&#8221;500ms&#8221; animation_intensity_slide=&#8221;10%&#8221; border_style=&#8221;solid&#8221; sticky=&#8221;off&#8221;][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row make_fullwidth=&#8221;on&#8221; custom_width_percent=&#8221;100%&#8221; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; make_equal=&#8221;on&#8221; background_color_1=&#8221;#e8e8e8&#8243; background_color_2=&#8221;#e8e8e8&#8243; background_color_3=&#8221;#e8e8e8&#8243; background_position_1=&#8221;top_left&#8221; background_position_2=&#8221;top_left&#8221; background_position_3=&#8221;top_left&#8221; background_repeat_1=&#8221;no-repeat&#8221; background_repeat_2=&#8221;no-repeat&#8221; background_repeat_3=&#8221;no-repeat&#8221; padding_top_1=&#8221;40px&#8221; padding_top_2=&#8221;40px&#8221; padding_top_3=&#8221;40px&#8221; padding_right_1=&#8221;40px&#8221; padding_right_2=&#8221;40px&#8221; padding_right_3=&#8221;40px&#8221; padding_bottom_1=&#8221;40px&#8221; padding_bottom_2=&#8221;40px&#8221; padding_bottom_3=&#8221;40px&#8221; padding_left_1=&#8221;40px&#8221; padding_left_2=&#8221;40px&#8221; padding_left_3=&#8221;40px&#8221; custom_css_main_1=&#8221;border-radius: 25px;||box-shadow: 3px 3px 3px #000;&#8221; custom_css_main_2=&#8221;border-radius: 25px;||box-shadow: 3px 3px 3px #000;&#8221; custom_css_main_3=&#8221;border-radius: 25px;||box-shadow: 3px 3px 3px #000;&#8221; _builder_version=&#8221;3.7&#8243;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.0.47&#8243; padding_bottom=&#8221;40px&#8221; padding_left=&#8221;40px&#8221; padding_right=&#8221;40px&#8221; padding_top=&#8221;40px&#8221; background_color=&#8221;#e8e8e8&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;no-repeat&#8221; custom_css_main=&#8221;border-radius: 25px;||box-shadow: 3px 3px 3px #000;&#8221;][et_pb_text _builder_version=&#8221;3.7&#8243;]<\/p>\n<h2 style=\"text-align: center;\">Tax Form W4<\/h2>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_10_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_9qlle\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Form W-4<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"10\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_10\" id=\"frm_hide_fields_10\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"9qlle\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_10\" name=\"frm_submit_entry_10\" value=\"440768ed13\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/397\" \/><div id=\"frm_field_208_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <label for=\"field_hn456\" class=\"frm_primary_label\">Marital Status (Select One)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_208-0\"><label for=\"field_hn456-0\">\t\t<input type=\"radio\" name=\"item_meta[208]\" id=\"field_hn456-0\" value=\"Single\"\n\t\t   data-invmsg=\"Marital Status (Select One) is invalid\" aria-invalid=\"false\"  \/> Single<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_208-1\"><label for=\"field_hn456-1\">\t\t<input type=\"radio\" name=\"item_meta[208]\" id=\"field_hn456-1\" value=\"Married\"\n\t\t   data-invmsg=\"Marital Status (Select One) is invalid\" aria-invalid=\"false\"  \/> Married<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_208-2\"><label for=\"field_hn456-2\">\t\t<input type=\"radio\" name=\"item_meta[208]\" id=\"field_hn456-2\" value=\"Married, but withhold at Single rate\"\n\t\t   data-invmsg=\"Marital Status (Select One) is invalid\" aria-invalid=\"false\"  \/> Married, but withhold at Single rate<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_210_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_w2o3w\" class=\"frm_primary_label\">Your Email Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_w2o3w\" name=\"item_meta[210]\" value=\"\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_204_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_2d8qn\" class=\"frm_primary_label\">First Name & Middle Initial\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2d8qn\" name=\"item_meta[204]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_203_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_m06op\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_m06op\" name=\"item_meta[203]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_205_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_uif67\" class=\"frm_primary_label\">Social Security Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_uif67\" name=\"item_meta[205]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_206_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_lbbaf\" class=\"frm_primary_label\">Address (Include Number, Street, and Apt# if applicable)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_lbbaf\" name=\"item_meta[206]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_207_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_caogq\" class=\"frm_primary_label\">City, State, Zip Code\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_caogq\" name=\"item_meta[207]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_238_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_hx1yf\" class=\"frm_primary_label\">Total Number of Allowances You're Claiming (<a target=\"blank\" href=\"https:\/\/apps.irs.gov\/app\/withholdingcalculator\/\">Click Here to Go to the IRS website and calculate this number<\/a>)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_hx1yf\" name=\"item_meta[238]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_239_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_iolsk\" class=\"frm_primary_label\">Additional amount, if any, you want withheld from each paycheck:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_iolsk\" name=\"item_meta[239]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_240_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_u48fh\" class=\"frm_primary_label\">Write \"EXEMPT\" if you claim exemption from having any money withheld from your paycheck. Leave blank if you are not exempt from withheld income taxes.\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u48fh\" name=\"item_meta[240]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_u48fh\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_u48fh\">You can claim this exemption if you meet both of the following: 1) Last year you had a right to a refund of all federal income tax withheld because you had no tax liability and 2) This year you expect a refund of all federal income tax withheld because you expect to have no tax liability.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_241_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\r\n    <label for=\"field_bthgv\" class=\"frm_primary_label\">Check below if your last name is different than the last name on your social security card:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_241-0\"><label for=\"field_bthgv-0\"><input type=\"checkbox\" name=\"item_meta[241][]\" id=\"field_bthgv-0\" value=\"Yes, my last name is different\"  data-invmsg=\"Check below if your last name is different than the last name on your social security card: is invalid\" aria-invalid=\"false\"   \/> Yes, my last name is different<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_209_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_iod59\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad209\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[209][typed]\" class=\"name\" id=\"field_iod59\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[209][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<div class=\"frm_verify\" >\n\t<label for=\"frm_email_10\">\n\t\tIf you are human, leave this field blank.\t<\/label>\n\t<input type=\"email\" class=\"frm_verify\" id=\"frm_email_10\" name=\"frm_verify\" value=\"\"  \/>\n<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;3.0.47&#8243; padding_bottom=&#8221;40px&#8221; padding_left=&#8221;40px&#8221; padding_right=&#8221;40px&#8221; padding_top=&#8221;40px&#8221; background_color=&#8221;#e8e8e8&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;no-repeat&#8221; custom_css_main=&#8221;border-radius: 25px;||box-shadow: 3px 3px 3px #000;&#8221;][et_pb_text _builder_version=&#8221;3.7&#8243;]<\/p>\n<h2 style=\"text-align: center;\">Authorization to Work Form I9<\/h2>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_11_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form \" id=\"form_3bwcm\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Form I-9<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"11\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_11\" id=\"frm_hide_fields_11\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"3bwcm\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_11\" name=\"frm_submit_entry_11\" value=\"440768ed13\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/397\" \/><div id=\"frm_field_211_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_6zbhr\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6zbhr\" name=\"item_meta[211]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_212_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_zaqf3\" class=\"frm_primary_label\">First Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_zaqf3\" name=\"item_meta[212]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_213_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_s04cu\" class=\"frm_primary_label\">Middle Initial\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_s04cu\" name=\"item_meta[213]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_214_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_yldm6\" class=\"frm_primary_label\">Other Last Names Used (If Applicable)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yldm6\" name=\"item_meta[214]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_215_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_2j5jx\" class=\"frm_primary_label\">Street Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_2j5jx\" name=\"item_meta[215]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_216_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_inqdu\" class=\"frm_primary_label\">Apt #\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_inqdu\" name=\"item_meta[216]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_217_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9wfav\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9wfav\" name=\"item_meta[217]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_218_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_yveqk\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_yveqk\" name=\"item_meta[218]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_219_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_sal1e\" class=\"frm_primary_label\">Zip Code\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_sal1e\" name=\"item_meta[219]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_220_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_gr8rk\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gr8rk\" name=\"item_meta[220]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_221_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_j07ow\" class=\"frm_primary_label\">Social Security Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_j07ow\" name=\"item_meta[221]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_222_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_htt3v\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_htt3v\" name=\"item_meta[222]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_223_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_715s4\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_715s4\" name=\"item_meta[223]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_224_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <label for=\"field_qm3ys\" class=\"frm_primary_label\">I attest, under penalty of perjury, that I am...\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"frm_opt_container\">\t\t<div class=\"frm_radio\" id=\"frm_radio_224-0\"><label for=\"field_qm3ys-0\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_qm3ys-0\" value=\"A citizen of the United States\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"I attest, under penalty of perjury, that I am... is invalid\" aria-invalid=\"false\"  \/> A citizen of the United States<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_224-1\"><label for=\"field_qm3ys-1\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_qm3ys-1\" value=\"A noncitizen national of the United States\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"I attest, under penalty of perjury, that I am... is invalid\" aria-invalid=\"false\"  \/> A noncitizen national of the United States<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_224-2\"><label for=\"field_qm3ys-2\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_qm3ys-2\" value=\"A lawful permanent resident\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"I attest, under penalty of perjury, that I am... is invalid\" aria-invalid=\"false\"  \/> A lawful permanent resident<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_224-4\"><label for=\"field_qm3ys-4\">\t\t<input type=\"radio\" name=\"item_meta[224]\" id=\"field_qm3ys-4\" value=\"4. An alien authorized to work\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" data-invmsg=\"I attest, under penalty of perjury, that I am... is invalid\" aria-invalid=\"false\"  \/> 4. An alien authorized to work<\/label><\/div>\n<\/div>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qm3ys\">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.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_225_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_x5ozs\" class=\"frm_primary_label\">Alien Registration Number\/USCIS Number:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_x5ozs\" name=\"item_meta[225]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_226_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_7kcgq\" class=\"frm_primary_label\">Until what date are you authorized to work?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_7kcgq\" name=\"item_meta[226]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_229_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_c7b26\" class=\"frm_primary_label\">Form I-94 Admission Number:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c7b26\" name=\"item_meta[229]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_230_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rxdha\" class=\"frm_primary_label\">Foreign Passport Number\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_rxdha\" name=\"item_meta[230]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_231_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_k4f1u\" class=\"frm_primary_label\">Country of Issuance\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_k4f1u\" name=\"item_meta[231]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_232_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_wvgn6\" class=\"frm_primary_label\">Signature\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <div class=\"sigPad\" id=\"sigPad232\" style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#cccccc;--bg-color:#ffffff;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px\">\n\t\t\t\t<ul class=\"sigNav\">\n\t\t\t<li class=\"drawIt\"><a href=\"#\" class=\"current\" title=\"Draw It\" aria-label=\"Draw It\"><i class=\"fas fa-pencil-alt\" aria-hidden><\/i><\/a><\/li>\n\t\t\t<li class=\"typeIt\"><a href=\"#\" title=\"Type It\" aria-label=\"Type It\"><i class=\"far fa-keyboard\" aria-hidden><\/i><\/a><\/li>\n\t\t<\/ul>\n\t\t\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[232][typed]\" class=\"name\" id=\"field_wvgn6\" autocomplete=\"off\" value=\"\" \/>\n\t\t<\/div>\n\t\t<canvas class=\"pad\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\t\t<input type=\"hidden\" name=\"item_meta[232][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_233_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_36s03\" class=\"frm_primary_label\">Today's Date\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_36s03\" name=\"item_meta[233]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<div class=\"frm_verify\" >\n\t<label for=\"frm_email_11\">\n\t\tIf you are human, leave this field blank.\t<\/label>\n\t<input type=\"email\" class=\"frm_verify\" id=\"frm_email_11\" name=\"frm_verify\" value=\"\"  \/>\n<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   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