Laserfiche WebLink
Q� <br />Company ID Number: 486671 <br />To' be accepted as a participant in E-Verify, you should only sign the Employer's Section <br />of the signature page. If you have any questions, contact E-Verify at 888-464-4218. <br />Employer Ziolkowski Construction, Inc. <br />Bill Favors <br />Name (Please Type or Print) <br />Electronically Signed <br />Title <br />1/10/2012 <br />Signature <br />Date <br />Department of Homeland Security — Verification Division <br />SCIS Verification Division <br />Name (Please Type or Print) <br />Electronicall Signed <br />itle <br />01/10/2012 <br />Signature <br />Date <br />Information Required for the E-Verify Program <br />Information relating to your Company: <br />Company Name: <br />iolkowskl Construction, Inc. <br />Company Facility Address: <br />4050 Ralph Jones Dr. <br />South Bend, IN 46628 <br />Company Alternate <br />Address: <br />County or Parish: <br />STJOSEPH <br />Employer Identification <br />Number: <br />P51446992 <br />Page 12 of 13 1 E-Verify NOU for Employer I Revision Date 09/01/09 www.dhs.gov/E®Verify <br />