ColoradoDivisionofLabor
63317thStreet,Suite200Denver,CO802023611(303)3188441www.colorado.gov/cdle/evr
RevisionDate:09/01/14
ExpirationDate:10/01/17
ColoradoAffirmationFormInstructions
EmploymentVerificationLaw,§82122,C.R.S.
OverviewoftheColoradoEmploymentVerificationLaw
TheemploymentverificationlawappliestoallpublicandprivateemployersinColorado,andisin
additiontoseparatefederalFormI9requirements.Employersmustcomplywiththeprovisionsofthe
lawforallColoradoemployeeshiredonorafterJanuary1,2007.Therearetwomainrequirements,
bothofwhichmustoccurwithin20calendardaysofhire:(1)anaffirmationrequirement,and(2)a
requirementtomakeandretaincopiesofemployeeidentityandemploymentauthorization
documentation(copiesoftheemployee’sidentityandemploymentauthorizationdocumentswhich
werepresentedforcompletionoftheFormI9).Visitwww.colorado.gov/cdle/evrformoreinformation.
CompletionoftheAffirmationForm
1. TheattachedaffirmationformisdesignedforusebyColoradoemployers.Bysigningtheform,the
employeraffirmstoallfouroftheemploymenteligibilitycomponentsfortheemployeelisted.
2. TheemployermusthavecompletedanaffirmationformforallColoradoemployeeshiredonorafter
January1,2007.
3. EffectiveOctober1,2014,ColoradoemployersmustusetheDivisionaffirmationformwitharevision
dateof09/01/14.
a. The09/01/14versionoftheformmustbeusedforallColoradoemployeeshiredbetween
October1,2014andOctober1,2017.
b. The09/01/14versionoftheformcannotbeusedforColoradoemployeeshiredpriorto
September1,2014.
4. Theformmustbecompletedwithin20calendardaysafterhiringeachemployee.Reviewthe
informationbelowifyouhavenotadheredtothisrequirement.
5. Theemployer,nottheemployee,isresponsibleforfillingoutandcompletingtheforminatimely
fashion.Theformmaybecompletedbytheemployer’sdesigneeorrepresentative.
6. Thefollowingitemsontheformmustbelegiblycompletedbytheemployer.Theemployermaynot
leaveanyoftheseitemsblankorincomplete:
a. Employeenameanddateofhire(Month/Day/Year).
b. Employername,signature,anddateofemployersignature(Month/Day/Year).
ColoradoDivisionofLabor
63317thStreet,Suite200Denver,CO802023611(303)3188441www.colorado.gov/cdle/evr
RetentionoftheAffirmationForm
Formsmustberetainedbytheemployerforthedurationoftheemployee’semployment.Theemployer
mustproducecopiesoftheformtotheColoradoDivisionofLaboruponrequest,butdoesnothaveto
submitformsabsentarequest.
FailuretoProperlyCompletetheAffirmationFormorWorkEligibilityDocumentationRequirements
Theemployermustprovideaccurateandcompleteinformationontheform.Provisionoffalseor
fraudulentinformationontheformmaysubjecttheemployertoasignificantfineand/oradditional
penalties.
Iftheemployerhasnotproperlycompletedtheaffirmationformwithin20calendardaysofhiringthe
employee,ortheemployerhasnotmadeandretainedcopiesofemployeeidentityandemployment
authorizationdocumentationwithin20calendardaysofhiringtheemployee:
1. DONOTcompleteanaffirmationformfortheaffectedemployee(s).Theemployercannotcomplete
avalidformoncethe20calendardayshaveelapsedsincehire.

2. DONOTbackdateorotherwiseenterincorrectinformationontotheformfortheaffected
employee(s).Theemployermustnotenterfalseorfraudulentinformationontotheform.
3. DONOTattempttomakeandretaincopiesofemployeeidentityandemploymentauthorization
documentationifyoudidnotcomplywiththisrequirementwithin20calendardaysofhiringthe
employee.Seekingsuchdocumentationafterthe20calendardayshaveelapseddoesnotcomply
withColoradolaw,andmayalsoviolateseparatefederalimmigrationlaws.
DOcomplywiththeemploymentverificationlawforallnewhiresgoingforward.Theemployermust:
(1)properlycompleteaffirmations,and(2)makeandretaincopiesofemployeeidentityand
employmentauthorizationdocumentation,within20calendardaysofhireforallemployeeshiredafter
thediscoveryofthehistoricalnoncompliance.
Followingthestepsabove,andengaginginotherappropriatecompliance
actions,mayreducethe
likelihoodofafine,ormaymitigatethevalueofafine,dependinguponthecircumstances.Consultwith
anattorneyforlegaladvice.

This form cannot be used for employees hired prior to September 1, 2014.
This mandatory affirmation is provided by the Colorado Division of Labor. Visit www.colorado.gov/cdle/evr for more information.
Revision Date: 09/01/14
Expiration Date: 10/01/17
Affirmation of Legal Work Status
Pursuant to § 8-2-122, Colorado Revised Statutes
Employee Name: _______________________________________________ __________
Last First Middle Date of Birth
Social Security Number: ___________________ Date of Hire: (MM/DD/YYYY)
In accordance with § 8-2-122, C.R.S., within 20 calendar days after hiring the new employee
listed above,
I affirm all four of the following by signing this form:
1. I have examined the legal work status of the above named employee.
2. I have retained file copies of the documents required by 8 U.S.C. sec. 1324a.
3. I have not altered or falsified the employee’s identification documents.
4. I have not knowingly hired an unauthorized alien.
____________________________________________ ______________________________
Print Name of Employer (or Designated Representative) Official Title
____________________________________________ _________________(MM/DD/YYYY)
Signature of Employer (or Designated Representative) Date Signed by Employer
____________________________________________ ______________________________
Business or Organization Name Employer Phone Number
The provision of false or fraudulent information on this form may subject the employer to a
significant fine and/or additional penalties.
This form and the documents required by 8 U.S.C. sec. 1324 (copies or electronic copies) will be
retained for the duration of the above named individual’s employment.
§ 8-2-122(2), C.R.S.: On and after January 1, 2007, within twenty days after hiring a new employee, each employer in Colorado
shall affirm that the employer has examined the legal work status of such newly-hired employee and has retained file copies of
the documents required by 8 U.S.C. sec. 1324a; that the employer has not altered or falsified the employee’s identification
documents; and that the employer has not knowingly hired an unauthorized alien. The employer shall keep a written or electronic
copy of the affirmation, and of the documents required by 8 U.S.C. sec. 1324a, for the term of employment of each employee.