New Hire Forms Checklist – School

Home , Moderator of the curia, Vicar General

Name: Date:

Mandatory Forms and Documents:

□ Offer letter □ Employment Application □ Employee Data Sheet □ W-4 □ M-4 □ Direct Deposit Form □ Confidentiality Agreement □ Code of Conduct and Conflict of Interest Policy □ Code of Ministerial Conduct (Ministry Roles) □ CORI Form □ Electronic Use Policy and Acknowledgement- School □ Sexual Harassment Policy □ I-9 Form □ I-9 List of Acceptable Documents □ I-9 Instructions

Additional Materials: □ Protecting God’s Children □ Parish Employee Handbook □ Parish Employee Handbook Acknowledgement

(Date)

(Candidate Name) (Candidate Street Address) (Candidate City/State/Zip) (Candidate Email)

Dear (Candidate Name):

On behalf of the (Insert Parish Name), it is a pleasure to convey to you an offer to join us as (Insert Position Title) for the (Insert Department Title). In this role, you will report directly to (Insert Supervisor/Manager), (Enter their title).

Your start date in this role is (Insert start date). As a (exempt or non‐exempt) employee, you will be paid (bi‐weekly or hourly) at rate of (Insert Rate) based on a (Insert Hours)‐hour work week, less any applicable deductions. You will be eligible for participation in benefit plans sponsored by the Archdiocese of Boston, and other benefits provided by us, to the extent you meet eligibility requirements for those benefits.

This offer is conditioned on the receipt of a CORI check that we require. You will receive a Criminal Offender Record Information (CORI) Acknowledgement Form (the “Acknowledgement Form”) and an appointment will be made for you to meet with an individual authorized by the Office of Background Screening of the Archdiocese who will verify certain information that you have provided on the Acknowledgement Form, examine an acceptable form of your government‐issued identification, sign the Acknowledgement Form and assist you in completing any other required paperwork regarding your background check.

Once you accept this offer, we also request that prior to, or on your first day of employment, you complete the required I‐9 Form and provide required information regarding your identity and employment eligibility.

This offer is not a guarantee of continued employment. You will be employed as an employee at will, which means that your employment may be terminated by us or by you at any time, for any reason or for no reason, with or without notice, and without further obligation to either of us.

Please plan to arrive at (Insert Time) on (Insert Start date) for your new hire orientation. We look forward to working with you. If you have any questions, please do not hesitate to contact me at (phone) or (email)

Sincerely,

(Name) (Title)

Acknowledged by: Name of Employee: ______

Signature: ______Date: ______Roman Catholic Archbishop of Boston Corporation Sole Application for Employment:

Personal:

Last Name First Middle Date

( ) Street Address Home Telephone

( ) City, State, Zip Cell/Business Telephone

Position Desired

Military:

Are you a Veteran? Yes No

Work Eligibility:

Are you legally eligible to work in the United States? Yes No

Education:

Did you # of Years Degree or Level Name/ Location Course of Study Graduate? Completed Diploma Y/N

Graduate

College

High School/ Vocational School

Additional Education Employment: Please list present or most recent position first. Please indicate volunteer work as well.

Company Name Telephone

( ) - Address Employed (month & year)

From: To: Name of Supervisor Reason for Leaving

Position Title/Responsibilities

Company Name Telephone

( ) - Address Employed (month & year)

From: To: Name of Supervisor Reason for Leaving

Position Title/Responsibilities

Company Name Telephone

( ) - Address Employed (month & year)

From: To: Name of Supervisor Reason for Leaving

Position Title/Responsibilities

______

May we contact the employers listed above? If not, indicate the one(s) you do not wish us to contact:

Skills/Professional Licenses:

Do you have any relevant Professional Licenses or Certificates Yes No If yes, please explain:

Typing (wpm)

Others special skills/training: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Signature:

I represent that the information contained in this application for employment is true and I understand that any misrepresentation of information on this application or presented in an employment interview or in support of my application may be grounds for denial of employment or my immediate dismissal. By submitting this application, I authorize the Roman Catholic Archbishop of Boston Corporation Sole to verify information contained in this application, or presented in support of this application, including verification of previous or present employment and verification of educational records and I authorize any previous or current employer or educational institution listed on this application to release such information to the Roman Catholic Archbishop of Boston Corporation Sole in connection with this application.

I understand that this application is not an offer of or contract of employment. I understand that regular employment depends upon satisfactory replies from my references; acceptable outcome of a criminal history records check, when required; and successful completion of a trial period of employment where applicable. Also, under the Immigrations and Reform Control Act of 1986, I will be required to produce proof of my identity and employment eligibility within three working days of my first day as a condition of continued employment. Any employment with the Roman Catholic Archbishop of Boston is not for any stated term and may be terminated with or without notice.

The Roman Catholic Archbishop of Boston Corporation Sole prohibits discrimination against any individual on the basis of race, color, national origin, religion, sex, age, physical or mental handicap, marital, parental or veteran status.

Applicant Signature Date

EMPLOYEE DATA SHEET

PERSONAL INFORMATION

Date: ______

Name: ______(Last) (First) (M.I.)

Present Address: ______(Street)

______(City) (St) (Zip)

Home Telephone: ______Cell Phone: ______

Personal E-mail Address: ______

Marital Status: ______Spouse’s Name:______

************************************************************************ EMERGENCY INFORMATION

In case of emergency, please notify:

Name: ______Relationship:______

Address: ______

Telephone: Home: (____) ______Work: (____) ______

************************************************************************ AUTOMOBILE INFORMATION

Reg. #1:______State: ___ Year: ____ Make: ______Model: ______Color: ____

Reg. #2:______State: ___ Year: ____ Make: ______Model: ______Color: ____

Employee’s Withholding Certificate OMB No. 1545-0074 Form W-4 ▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. ▶ Department of the Treasury Give Form W-4 to your employer. 2020 Internal Revenue Service ▶ Your withholding is subject to review by the IRS. Step 1: (a) First name and middle initial Last name (b) Social security number Enter Address ▶ Does your name match the Personal name on your social security card? If not, to ensure you get Information City or town, state, and ZIP code credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov. (c) Single or Married filing separately Married filing jointly (or Qualifying widow(er)) Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the online estimator, and privacy.

Step 2: Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse Multiple Jobs also works. The correct amount of withholding depends on income earned from all of these jobs. or Spouse Do only one of the following. Works (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . ▶

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: If your income will be $200,000 or less ($400,000 or less if married filing jointly): Claim Multiply the number of qualifying children under age 17 by $2,000 ▶ $ Dependents

Multiply the number of other dependents by $500 . . . . ▶ $

Add the amounts above and enter the total here ...... 3 $ Step 4 (a) Other income (not from jobs). If you want tax withheld for other income you expect (optional): this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income ...... 4(a) $ Other Adjustments (b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here ...... 4(b) $

Step 5: Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete. Sign Here ▲ ▲ Employee’s signature (This form is not valid unless you sign it.) Date

Employers Employer’s name and address First date of Employer identification Only employment number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2020) Form W-4 (2020) Page 2 General Instructions Specific Instructions Future Developments Step 1(c). Check your anticipated filing status. This will determine the standard deduction and tax rates used to For the latest information about developments related to compute your withholding. Form W-4, such as legislation enacted after it was published, go to www.irs.gov/FormW4. Step 2. Use this step if you (1) have more than one job at the same time, or (2) are married filing jointly and you and your Purpose of Form spouse both work. Complete Form W-4 so that your employer can withhold the Option (a) most accurately calculates the additional tax correct federal income tax from your pay. If too little is you need to have withheld, while option (b) does so with a withheld, you will generally owe tax when you file your tax little less accuracy. return and may owe a penalty. If too much is withheld, you will If you (and your spouse) have a total of only two jobs, you generally be due a refund. Complete a new Form W-4 when may instead check the box in option (c). The box must also be changes to your personal or financial situation would change checked on the Form W-4 for the other job. If the box is the entries on the form. For more information on withholding checked, the standard deduction and tax brackets will be cut and when you must furnish a new Form W-4, see Pub. 505. in half for each job to calculate withholding. This option is Exemption from withholding. You may claim exemption from roughly accurate for jobs with similar pay; otherwise, more tax withholding for 2020 if you meet both of the following than necessary may be withheld, and this extra amount will be conditions: you had no federal income tax liability in 2019 and larger the greater the difference in pay is between the two jobs. you expect to have no federal income tax liability in 2020. You Multiple jobs. Complete Steps 3 through 4(b) on only had no federal income tax liability in 2019 if (1) your total tax on ▲! one Form W-4. Withholding will be most accurate if line 16 on your 2019 Form 1040 or 1040-SR is zero (or less CAUTION you do this on the Form W-4 for the highest paying job. than the sum of lines 18a, 18b, and 18c), or (2) you were not required to file a return because your income was below the Step 3. Step 3 of Form W-4 provides instructions for filing threshold for your correct filing status. If you claim determining the amount of the child tax credit and the credit exemption, you will have no income tax withheld from your for other dependents that you may be able to claim when paycheck and may owe taxes and penalties when you file your you file your tax return. To qualify for the child tax credit, the 2020 tax return. To claim exemption from withholding, certify child must be under age 17 as of December 31, must be that you meet both of the conditions above by writing “Exempt” your dependent who generally lives with you for more than on Form W-4 in the space below Step 4(c). Then, complete half the year, and must have the required social security Steps 1a, 1b, and 5. Do not complete any other steps. You will number. You may be able to claim a credit for other need to submit a new Form W-4 by February 16, 2021. dependents for whom a child tax credit can’t be claimed, such as an older child or a qualifying relative. For additional Your privacy. If you prefer to limit information provided in eligibility requirements for these credits, see Pub. 972, Child Steps 2 through 4, use the online estimator, which will also Tax Credit and Credit for Other Dependents. You can also increase accuracy. include other tax credits in this step, such as education tax As an alternative to the estimator: if you have concerns credits and the foreign tax credit. To do so, add an estimate with Step 2(c), you may choose Step 2(b); if you have of the amount for the year to your credits for dependents concerns with Step 4(a), you may enter an additional amount and enter the total amount in Step 3. Including these credits you want withheld per pay period in Step 4(c). If this is the will increase your paycheck and reduce the amount of any only job in your household, you may instead check the box refund you may receive when you file your tax return. in Step 2(c), which will increase your withholding and Step 4 (optional). significantly reduce your paycheck (often by thousands of dollars over the year). Step 4(a). Enter in this step the total of your other estimated income for the year, if any. You shouldn’t include When to use the estimator. Consider using the estimator at income from any jobs or self-employment. If you complete www.irs.gov/W4App if you: Step 4(a), you likely won’t have to make estimated tax 1. Expect to work only part of the year; payments for that income. If you prefer to pay estimated tax rather than having tax on other income withheld from your 2. Have dividend or capital gain income, or are subject to paycheck, see Form 1040-ES, Estimated Tax for Individuals. additional taxes, such as the additional Medicare tax; Step 4(b). Enter in this step the amount from the Deductions 3. Have self-employment income (see below); or Worksheet, line 5, if you expect to claim deductions other than 4. Prefer the most accurate withholding for multiple job the basic standard deduction on your 2020 tax return and situations. want to reduce your withholding to account for these Self-employment. Generally, you will owe both income and deductions. This includes both itemized deductions and other self-employment taxes on any self-employment income you deductions such as for student loan interest and IRAs. receive separate from the wages you receive as an Step 4(c). Enter in this step any additional tax you want employee. If you want to pay these taxes through withheld from your pay each pay period, including any withholding from your wages, use the estimator at amounts from the Multiple Jobs Worksheet, line 4. Entering an www.irs.gov/W4App to figure the amount to have withheld. amount here will reduce your paycheck and will either increase Nonresident alien. If you’re a nonresident alien, see Notice your refund or reduce any amount of tax that you owe. 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form. Form W-4 (2020) Page 3 Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job. Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App.

1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the “Lower Paying Job” column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3 ...... 1 $

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

a Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries and enter that value on line 2a ...... 2a $

b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount on line 2b ...... 2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c ...... 2c $

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc...... 3

4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld) ...... 4 $ Step 4(b)—Deductions Worksheet (Keep for your records.)

1 Enter an estimate of your 2020 itemized deductions (from Schedule A (Form 1040 or 1040-SR)). Such deductions may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 10% of your income ...... 1 $

• $24,800 if you’re married filing jointly or qualifying widow(er) 2 Enter: • $18,650 if you’re head of household ...... 2 $ { • $12,400 if you’re single or married filing separately }

3 If line 1 is greater than line 2, subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-” . . 3 $

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Schedule 1 (Form 1040 or 1040-SR)). See Pub. 505 for more information . . . 4 $

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 ...... 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information You are not required to provide the information requested on a form that is on this form to carry out the Internal Revenue laws of the United States. Internal subject to the Paperwork Reduction Act unless the form displays a valid OMB Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to control number. Books or records relating to a form or its instructions must be provide this information; your employer uses it to determine your federal income retained as long as their contents may become material in the administration of tax withholding. Failure to provide a properly completed form will result in your any Internal Revenue law. Generally, tax returns and return information are being treated as a single person with no other entries on the form; providing confidential, as required by Code section 6103. fraudulent information may subject you to penalties. Routine uses of this The average time and expenses required to complete and file this form will vary information include giving it to the Department of Justice for civil and criminal depending on individual circumstances. For estimated averages, see the litigation; to cities, states, the District of Columbia, and U.S. commonwealths and instructions for your income tax return. possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We If you have suggestions for making this form simpler, we would be happy to hear may also disclose this information to other countries under a tax treaty, to federal from you. See the instructions for your income tax return. and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Form W-4 (2020) Page 4 Married Filing Jointly or Qualifying Widow(er) Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 - Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000 $0 - 9,999 $0 $220 $850 $900 $1,020 $1,020 $1,020 $1,020 $1,020 $1,210 $1,870 $1,870 $10,000 - 19,999 220 1,220 1,900 2,100 2,220 2,220 2,220 2,220 2,410 3,410 4,070 4,070 $20,000 - 29,999 850 1,900 2,730 2,930 3,050 3,050 3,050 3,240 4,240 5,240 5,900 5,900 $30,000 - 39,999 900 2,100 2,930 3,130 3,250 3,250 3,440 4,440 5,440 6,440 7,100 7,100 $40,000 - 49,999 1,020 2,220 3,050 3,250 3,370 3,570 4,570 5,570 6,570 7,570 8,220 8,220 $50,000 - 59,999 1,020 2,220 3,050 3,250 3,570 4,570 5,570 6,570 7,570 8,570 9,220 9,220 $60,000 - 69,999 1,020 2,220 3,050 3,440 4,570 5,570 6,570 7,570 8,570 9,570 10,220 10,220 $70,000 - 79,999 1,020 2,220 3,240 4,440 5,570 6,570 7,570 8,570 9,570 10,570 11,220 11,240 $80,000 - 99,999 1,060 3,260 5,090 6,290 7,420 8,420 9,420 10,420 11,420 12,420 13,260 13,460 $100,000 - 149,999 1,870 4,070 5,900 7,100 8,220 9,320 10,520 11,720 12,920 14,120 14,980 15,180 $150,000 - 239,999 2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,190 16,050 16,250 $240,000 - 259,999 2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,520 17,170 18,170 $260,000 - 279,999 2,040 4,440 6,470 7,870 9,190 10,390 11,590 13,120 15,120 17,120 18,770 19,770 $280,000 - 299,999 2,040 4,440 6,470 7,870 9,190 10,720 12,720 14,720 16,720 18,720 20,370 21,370 $300,000 - 319,999 2,040 4,440 6,470 8,200 10,320 12,320 14,320 16,320 18,320 20,320 21,970 22,970 $320,000 - 364,999 2,720 5,920 8,750 10,950 13,070 15,070 17,070 19,070 21,290 23,590 25,540 26,840 $365,000 - 524,999 2,970 6,470 9,600 12,100 14,530 16,830 19,130 21,430 23,730 26,030 27,980 29,280 $525,000 and over 3,140 6,840 10,170 12,870 15,500 18,000 20,500 23,000 25,500 28,000 30,150 31,650 Single or Married Filing Separately Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -

Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000 $0 - 9,999 $460 $940 $1,020 $1,020 $1,470 $1,870 $1,870 $1,870 $1,870 $2,040 $2,040 $2,040 $10,000 - 19,999 940 1,530 1,610 2,060 3,060 3,460 3,460 3,460 3,640 3,830 3,830 3,830 $20,000 - 29,999 1,020 1,610 2,130 3,130 4,130 4,540 4,540 4,720 4,920 5,110 5,110 5,110 $30,000 - 39,999 1,020 2,060 3,130 4,130 5,130 5,540 5,720 5,920 6,120 6,310 6,310 6,310 $40,000 - 59,999 1,870 3,460 4,540 5,540 6,690 7,290 7,490 7,690 7,890 8,080 8,080 8,080 $60,000 - 79,999 1,870 3,460 4,690 5,890 7,090 7,690 7,890 8,090 8,290 8,480 9,260 10,060 $80,000 - 99,999 2,020 3,810 5,090 6,290 7,490 8,090 8,290 8,490 9,470 10,460 11,260 12,060 $100,000 - 124,999 2,040 3,830 5,110 6,310 7,510 8,430 9,430 10,430 11,430 12,420 13,520 14,620 $125,000 - 149,999 2,040 3,830 5,110 7,030 9,030 10,430 11,430 12,580 13,880 15,170 16,270 17,370 $150,000 - 174,999 2,360 4,950 7,030 9,030 11,030 12,730 14,030 15,330 16,630 17,920 19,020 20,120 $175,000 - 199,999 2,720 5,310 7,540 9,840 12,140 13,840 15,140 16,440 17,740 19,030 20,130 21,230 $200,000 - 249,999 2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930 $250,000 - 399,999 2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930 $400,000 - 449,999 2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,450 19,940 21,240 22,540 $450,000 and over 3,140 6,230 8,810 11,310 13,810 15,710 17,210 18,710 20,210 21,700 23,000 24,300 Head of Household Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 - Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000 $0 - 9,999 $0 $830 $930 $1,020 $1,020 $1,020 $1,480 $1,870 $1,870 $1,930 $2,040 $2,040 $10,000 - 19,999 830 1,920 2,130 2,220 2,220 2,680 3,680 4,070 4,130 4,330 4,440 4,440 $20,000 - 29,999 930 2,130 2,350 2,430 2,900 3,900 4,900 5,340 5,540 5,740 5,850 5,850 $30,000 - 39,999 1,020 2,220 2,430 2,980 3,980 4,980 6,040 6,630 6,830 7,030 7,140 7,140 $40,000 - 59,999 1,020 2,530 3,750 4,830 5,860 7,060 8,260 8,850 9,050 9,250 9,360 9,360 $60,000 - 79,999 1,870 4,070 5,310 6,600 7,800 9,000 10,200 10,780 10,980 11,180 11,580 12,380 $80,000 - 99,999 1,900 4,300 5,710 7,000 8,200 9,400 10,600 11,180 11,670 12,670 13,580 14,380 $100,000 - 124,999 2,040 4,440 5,850 7,140 8,340 9,540 11,360 12,750 13,750 14,750 15,770 16,870 $125,000 - 149,999 2,040 4,440 5,850 7,360 9,360 11,360 13,360 14,750 16,010 17,310 18,520 19,620 $150,000 - 174,999 2,040 5,060 7,280 9,360 11,360 13,480 15,780 17,460 18,760 20,060 21,270 22,370 $175,000 - 199,999 2,720 5,920 8,130 10,480 12,780 15,080 17,380 19,070 20,370 21,670 22,880 23,980 $200,000 - 249,999 2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870 $250,000 - 349,999 2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870 $350,000 - 449,999 2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,900 25,200 $450,000 and over 3,140 6,840 9,560 12,140 14,640 17,140 19,640 21,530 23,030 24,530 25,940 27,240 ACHUS SS ET Rev. 8/02 A T FORM MASSACHUSETTS EMPLOYEE’S WITHHOLDING EXEMPTION CERTIFICATE S

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L T R A R C E E I B D I A L T M B S V V M E R Print full name ...... Social Security no...... ENT OF Print home address...... City...... State ...... Zip ......

Employee: HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS File this form or Form W-4 with 1. Your personal exemption. Write the figure “1.” If you are age 65 or over or will be before next year, write “2” ...... your employer. Otherwise, Massachusetts Income Taxes 2. If married and if exemption for spouse is allowed, write the figure “3.” If your spouse is age 65 or over or will will be withheld from your wages without exemptions. be before next year and if otherwise qualified, write “4.” See Instruction C ...... 3. Write the number of your qualified dependents. See Instruction D ...... Employer: Keep this certificate with your 4. Add the number of exemptions which you have claimed above and write the total ...... records. If the employee is 5. Additional withholding per pay period under agreement with employer $ ______believed to have claimed excessive exemptions, the A. Check if you will file as head of household on your tax return. Massachusetts Department of Revenue should be so B. Check if you are blind. C. Check if spouse is blind and not subject to withholding. advised. D. Check if you are a full-time student engaged in seasonal, part-time or temporary employment whose estimated annual income will not exceed $8,000. EMPLOYER: DO NOT withhold if Box D is checked.

I certify that the number of withholding exemptions claimed on this certificate does not exceed the number to which I am entitled.

Date ...... Signed ...... THIS FORM MAY BE REPRODUCED

THE COMMONWEALTH OF MASSACHUSETTS, DEPARTMENT OF REVENUE A. Number. If you claim more than the correct number of exemptions, civil C. Spouse. If your spouse is not working or if she or he is working but not and criminal penalties may be imposed. You may claim a smaller number of claiming the personal exemption or the age 65 or over exemption, generally exemptions. If you do not file a certificate, your employer must withhold on you may claim those exemptions in line 2. However, if you are planning to file the basis of no exemptions. separate annual tax returns, you should not claim withholding exemptions for your spouse or for any dependents that will not be claimed on your annual tax If you expect to owe more income tax than will be withheld, you may either return. claim a smaller number of exemptions or enter into an agreement with your employer to have additional amounts withheld. If claiming a wife or husband, write “3” in line 2. Using “3” is the withholding system adjustment for the $3,300 exemption for a spouse. You should claim the total number of exemptions to which you are entitled to prevent excessive overwithholding, unless you have a significant amount of D. Dependent(s). You may claim an exemption in line 3 for each individual other income. who qualifies as a dependent under the Federal Income Tax Law. In addition, if one or more of your dependents will be under age 12 at year end, add “1” If you work for more than one employer at the same time, you must to your dependents total for line 3. not claim any exemptions with employers other than your principal employer. You are not allowed to claim “federal withholding deductions and adjustments” under the Massachusetts withholding system. If you are married and if your spouse is subject to withholding, each may claim a personal exemption. If you have income not subject to withholding, you are urged to have additional amounts withheld to cover your tax liability on such income. B. Changes. You may file a new certificate at any time if the number of ex- See line 5. emptions increases.Youmust file a new certificate within 10 days if the number of exemptions previously claimed by you decreases. For example, if during the year your dependent son’s income indicates that you will not provide over half of his support for the year, you must file a new certificate.

IF YOU CLAIM THE SAME NUMBER OF EXEMPTIONS FOR MASSACHUSETTS AND U.S. INCOME TAXES, COMPLETE U.S. FORM W-4 ONLY.

60M 1/01 CRP0101 printed on recycled paper Roman Catholic Archdiocese of Boston Direct Deposit Form

Employee Name: ______Location: ______

Please Check One: New Hire: Change: Date of change:

Bank/Institution Name: ______

Bank/Institution Routing Number: ______

Bank/Institution Account Number: ______

Type of Account: Checking Saving Other:

Bank/Institution Name: ______

Bank/Institution Routing Number: ______

Bank/Institution Account Number: ______

Type of Account: Checking Saving Other:

Allocation of funds:

You can have your paycheck deposited into more than one bank account. Please indicate below how much of your bi‐weekly paycheck you would like to be deposited into the corresponding account.

Entire Amount: Deposited into account #: ______

Partial Amount: ______Deposited into account #: ______

I hereby authorize the Archdiocese of Boston to deposit the payment described above to my account at the financial institution named above. Also, the Archdiocese of Boston is authorized to adjust any other deposit which is caused to be made to my account. I will not hold the financial institution named above liable for any erroneous deposits or adjustments made by the Archdiocese of Boston.

Please check your payroll check stub to verify account and dollar amounts.

Signed: ______Date: ______

Note: For Checking Accounts attach a voided check or copy of one with this form The Roman Catholic Archdiocese of Boston Confidentiality Agreement

AGREEMENT entered into on this date, (mm/dd/yyyy), by and between Roman Catholic Archbishop of Boston, a Corporation Sole (“RCAB”) and , a staff member of RCAB (the “Staff Member”).

WHEREAS, RCAB is willing to engage or continue to engage the Staff Member upon certain representations, warranties and covenants by the Staff Member as to the use of Restricted and Confidential Information (as hereinafter defined) and as to the ownership of Proprietary Rights (as hereinafter defined); and

NOW, THEREFORE, in consideration of RCAB's engagement of the Staff Member, the Staff Member represents and warrants to, and agrees with, RCAB as follows:

I. NON-DISCLOSURE OF CONFIDENTIAL INFORMATION a. Confidential Information,

For the purposes of this Agreement "Confidential Information" shall mean information or material proprietary to RCAB and/or any of its affiliates (together with RCAB, collectively the “RCAB Entities” and individually an “RCAB Entity”), or designated as confidential by any RCAB Entity and not generally known to persons not employed by or associated with an RCAB Entity, which the Staff Member develops or which the Staff Member may obtain knowledge of or access to in connection with or as a result of the Staff Member's relationship with any RCAB Entity(including, without limitation, information conceived, originated, discovered or developed in whole or in part by the Staff Member).

Confidential Information includes, but is not limited to, the following types of information and information of a similar nature (whether or not reduced to writing): all donor information and donor lists, parish information and parish lists, technology, know-how, processes, trade secrets, contracts, proprietary information, historical and projected financial information, medical-related information, operating data and organizational cost structures, strategic or management plans, in each case whether received before or after the date hereof. Confidential Information also includes: Any information described above which an RCAB Entity obtains from any other party and which any RCAB Entity treats as proprietary or designates as confidential, whether or not owned or developed by an RCAB Entity; and any information from or pertaining to any person having a business relationship with any RCAB Entity which is designated as confidential by any such person, including, but not limited to, confidential securities and trading information.

Confidential Information shall not include any information or materials which are in the public domain during the period of the Staff Member's engagement or thereafter, provided that such information or materials are not in the public domain as a consequence of disclosure by the Staff Member in violation of Section 1.b of this Agreement. b. Non-Disclosure of Confidential Information.

The Staff Member covenants and agrees with RCAB that, during his time with RCAB and thereafter, the Staff Member will hold all Confidential Information in confidence for the sole benefit of the RCAB Entities and will not directly or indirectly reveal, report, publish, disclose or transfer any Confidential Information to any person or entity other than an RCAB Entity or staff members thereof so authorized at the time of such disclosure, or to such other persons to whom the Staff Member has been specifically instructed by an officer of RCAB to make such disclosure and, in all cases only to the extent required in the course of the Staff Member's duties performed on behalf of an RCAB Entity. The Staff Member further agrees, on his own behalf and on behalf of his heirs and representatives, that upon termination of his engagement by RCAB, all notes, letters, documents, records and any other written, printed or recorded materials, which are then in the Staff Member's possession 1 or control and which may contain any Confidential information, shall be delivered to RCAB and that no copies or summaries thereof shall be retained or used by the Staff Member for any purpose.

II. OWNERSHIP OF PROPRIETARY RIGHTS a. Proprietary Rights.

For the purposes of this Agreement, "Proprietary Rights" shall mean all right, title and interest (including any copyrights or patent rights) in and to, or associated with, or arising from, any and all notes, data, reference materials, sketches, drawings, memoranda, documentation, or records in any way incorporating or reflecting any Confidential Information and any original works of authorship, inventions or ideas, whether or not fixed in a tangible medium of expression, which are conceived or developed in whole or in part by the Staff Member alone or in conjunction with others, whether or not conceived or developed during regular working hours and whether or not conceived or developed during or after the term of his engagement with, or association with, any RCAB Entity, which are made through the use of any Confidential Information or any equipment, facilities, supplies, or trade secrets of an RCAB Entity, or which relate to the business or actual or demonstrably anticipated research and development of an RCAB Entity, or which result from any work performed by the Staff Member for an RCAB Entity. b. Ownership of Proprietary Rights.

The Staff Member covenants and agrees with RCAB that all Proprietary Rights shall belong exclusively to RCAB (or other applicable RCAB Entity). The Staff Member agrees that, upon request of RCAB and without any separate remuneration or compensation, the Staff Member shall take such action and execute and deliver such documents and instruments as may be necessary or proper to vest all such Proprietary Rights in RCAB (or such RCAB Entity). Without limiting the foregoing, the Staff Member further agrees that RCAB (or the applicable RCAB Entity) shall be deemed the author under the United States Copyright Act of any original works of authorship to which the Staff Member made a contribution; provided, however, that in the event and to the extent such works are determined not to constitute “works made for hire” as a matter of law, the Staff Member hereby irrevocably assigns and transfers to RCAB (or such RCAB Entity) all right, title and interest in such works, including but not limited to copyrights.

III. REMEDIES

Any breach of the provisions of Articles I or II of this Agreement will result in the immediate termination of the Staff Member’s engagement with RCAB. The Staff Member and RCAB specifically acknowledge and agree that any breach of the provisions of Articles I and II of this Agreement is likely to result in irreparable injury to RCAB and/or one or more of the RCAB Entities and that the remedy at law alone will be an inadequate remedy for such breach, and that in addition to any other remedy it may have, RCAB shall be entitled to enforce the specific performance of this Agreement by the Staff Member and to seek both temporary and permanent injunctive relief (to the extent permitted by law or In equity) without the necessity of proving actual damages.

V. GENERAL PROVISIONS a. Severability

The Staff Member and RCAB hereby expressly agree that the provisions of this Agreement are severable and, in the event that any provision hereof or any obligation or a grant of rights by the Staff Member hereunder is found invalid or unenforceable (in whole or in part) pursuant to judicial decree or decision by a court of competent jurisdiction, any such provision, obligation or grant of rights shall be deemed and construed to extend only to the maximum extent permitted by law, and the remainder of this Agreement shall remain valid and enforceable according to its terms.

2 b. Counterparts

This Agreement may be executed in two (2) counterparts; each of which shall be considered and have the force and effect of an original. c. Governing Law

This Agreement shall be governed by the laws of The Commonwealth of Massachusetts applicable to contracts between residents of The Commonwealth of Massachusetts, which are wholly executed and performed in The Commonwealth of Massachusetts. This Agreement contains the full and complete understanding of the parties with respect to the subject matter hereof and supersedes all prior representations and understandings, whether oral or written. THE EXECUTION OF THIS AGREEMENT IS MY OWN AND VOLUNTARY ACT AND DEED.

IN WITNESS WHEREOF, RCAB has caused this Agreement to be signed by its duly authorized representative below, and the Staff Member has hereunto set his or her hand, all as of the date set forth below.

STAFF MEMBER Roman Catholic Archbishop of Boston

Signature: By:

Name (print): Name:

Date: Title: School

Archdiocese of Boston

Code of Conduct and Conflict of Interest Policy

Preamble

The Roman Catholic Archbishop of Boston, a Corporation Sole, organized and existing under the laws of the Commonwealth of Massachusetts, Chapter 506 of the Special Acts of 1897, (hereafter, “the Archdiocese”) places the highest value on the integrity and high moral standards of each of the bishops, priests, deacons, religious, seminarians, pastoral ministers, administrators, lay employees, officers, directors, trustees, governors, members, and volunteers (collectively, “Church Personnel”) in our parishes, agencies, schools and organizations sponsored by the Archdiocese or for which the Archdiocese or the Roman Catholic Archbishop of Boston (the “Archbishop”) has the direct or indirect right (whether alone or in conjunction with others) to elect or appoint officers, directors, trustees, governors and/or members (collectively, “Archdiocesan Affiliated Organizations”). All Church Personnel are responsible for complying with (i) all applicable federal and Massachusetts laws, rules and regulations, (iii) the Code of Canon Law, (ii) this Code of Conduct and Conflict of Interest Policy of the Archdiocese of Boston (hereafter the “Code”) and (iv) all other applicable policies of the Archdiocese and applicable Archdiocesan Affiliated Organizations. All Church Personnel must uphold Christian values and conduct and work diligently to serve and enhance the mission of the Church. This Code provides a set of standards for conduct in certain situations and is designed to deter wrongdoing and to promote honest and ethical conduct.

The public and private conduct of Church Personnel can be a source of inspiration and motivation, but it can also scandalize and undermine the faith of the people that are served. Church Personnel must at all times be aware of the responsibilities that accompany their work. It is essential, therefore, that anyone who undertakes a position of ministry, employment or leadership in the Archdiocese or for any Archdiocesan Affiliated Organization, be ever mindful of the trust that has been placed in him or her. The faithful discharge of the responsibilities that accompany this work requires constant and prayerful reflection since all of us must be sustained by God’s goodness and grace.

Responsibility for adherence to the Code rests with each individual. This responsibility requires all Church Personnel to periodically take a personal inventory. It is hoped that the Code will assist in this task. Church Personnel who disregard or violate this Code will be subject to remedial action. This action can take several forms, from an oral or written warning to removal and termination of employment or services, depending on the nature and circumstances of the offense.

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While no policy can anticipate all of the challenges and situations that may arise, the Code communicates key guidelines and will assist in making decisions that are ethical and in accordance with applicable legal requirements, and, to the extent applicable to various Church Personnel, the Archdiocesan Code of Ministerial Behavior, the Pastoral Center Staff Handbook, the Archdiocesan Finance Council Charter, the Parish Administration Manual, the governing documents and policies of Archdiocesan Affiliated Organizations and other Archdiocesan policies. Each year all Church Personnel will read or have read to them or listen on CD or tape to, this Code and sign the proper acknowledgement of receipt form attached to this Code and submit such form to their Human Resource Department or to such other person as may be designated in writing.

Principles of Ethics and Integrity

As representatives of the Archdiocese or any Archdiocesan Affiliated Organization, and regardless of the pressures inherent in conducting Church affairs, all Church Personnel must act responsibly and in a manner that will reflect favorably on the Archdiocese. Accordingly:

Church Personnel will conduct themselves in a manner that is consistent with the teachings of the Roman Catholic Church as enunciated by the Holy Father and the Bishops in communion with him; more specifically, Church Personnel shall, in all such matters, accept, rely upon and defer to the teaching authority of the Archbishop in all matters of faith and morals.

Church Personnel will exhibit the highest Christian ethical standards and personal integrity.

Church Personnel will continually and objectively examine and evaluate their own actions and intentions to ensure that their behavior promotes the welfare of the Archdiocese and each applicable Archdiocesan Affiliated Organization and exemplifies the moral traditions of the Church.

Church personnel will always be in compliance with applicable law.

Church Personnel will establish clear, appropriate boundaries with anyone with whom they have a ministerial, business, professional or social relationship.

Church Personnel will provide an environment that is free from physical, psychological, emotional, written or oral intimidation or harassment.

Church Personnel will conduct their relationships with others in a manner that is free of deception, manipulation and/or exploitation. Page 2 of 15

Church Personnel will not take unfair advantage of a counseling relationship for their personal benefit.

Church Personnel will not use their position to exercise unreasonable or inappropriate power, influence or authority.

Church Personnel are never to offer or accept inducements or gratuities that can subject them or the Archdiocese or any Archdiocesan Affiliated Organization to criminal or civil penalties.

Personal loans from the Archdiocese or any Archdiocesan Affiliated Organization to any board member of any Archdiocesan Affiliated Organization are strictly prohibited.

Church Personnel may never authorize payment knowing that any part of the payment will be used for any purpose other than what is described in documents supporting the payment.

Church Personnel will be responsible stewards of the resources, human and financial, of the Archdiocese and any Archdiocesan Affiliated Organization with which they are associated, observing both canon and civil law, and making decisions concerning the disposition of resources that reflect Catholic social teaching.

Church Personnel will not make false accusations against another, or reveal the faults and failings of others to anyone who is not in a position that necessitates a need to know.

Church Personnel will share concerns about suspicions of inappropriate behavior with the appropriate supervisory or management representative.

Confidentiality

All records and information of the Archdiocese and each Archdiocesan Affiliated Organization (“Archdiocesan Information”) are considered confidential. Therefore, Church Personnel must treat all Archdiocesan Information accordingly. No Archdiocesan Information, including, without limitation, documents, notes, files, records, oral information, computer files or similar materials may be removed, copied or forwarded from the premises of the Archdiocese or any Archdiocesan Affiliated Organization without permission from an appropriate supervisory or management representative or except in the ordinary course of performing duties on behalf of the Archdiocese.

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Church Personnel may not disclose or forward any confidential information, purposefully or inadvertently through casual conversation, to any unauthorized person inside or outside the Archdiocese or any Archdiocesan Affiliated Organization. Church Personnel who are unsure about the confidential nature of specific information should ask an appropriate supervisory or management representative for clarification.

Accountability

The Archdiocese and all Archdiocesan Affiliated Organizations are responsible to their respective stakeholders, which include donors and others who have placed their trust in the Church. To uphold this trust, all Church Personnel will:

Promote responsible stewardship of all resources of the Archdiocese and Archdiocesan Affiliated Organizations, including donations, grants, program fees, and all financial support.

Use all resources of the Archdiocese and Archdiocesan Affiliated Organizations only for Church-related purposes. Church resources are never to be used for personal purposes, even if the use is intended to be temporary.

Use all resources of the Archdiocese and Archdiocesan Affiliated Organizations in a prudent-like manner, avoiding unnecessary and excessive spending and wastefulness.

Use credit cards, vendor relationships and lines of credit of the Archdiocese and Archdiocesan Affiliated Organizations only for their permitted purposes. They are never to be used for personal transactions, even if it is intended that funds of the Archdiocese and Archdiocesan Affiliated Organizations will not be used for payment.

Not be a party to any fraud or embezzlement, or neglect their duty to safeguard all assets of the Archdiocese and Archdiocesan Affiliated Organizations.

Conflicts of Interest

All Church Personnel, as well as members of their Immediate Family (as defined below), should avoid any situation that may create or appear to create a conflict between his or her personal interests and the interests of the Archdiocese or any Archdiocesan Affiliated Organization.

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A conflict of interest can exist when persons employed by the Archdiocese (such as parishes, parish schools, the Pastoral Center) or an Archdiocesan Affiliated Organization (such as an independent school sponsored by the Archdiocese or a corporation or organization under the auspices of the Archdiocese), or volunteering for the Archdiocese or an Archdiocesan Affiliated Organization by serving as a trustee, director, governor, officer or having other governance authority or by serving on advisory or consultative boards or committees have a direct or indirect “financial interest” as defined below.

A person has a “financial interest” if the person has, directly or indirectly, through business, investment or Immediate Family ( “Immediate Family” meaning such person’s spouse, parents, stepparents, children, stepchildren, siblings, mothers and fathers-in-law, sons and daughters-in-law, and brothers and sisters-in-law and any person sharing the household of such person (other than a tenant or employee). any one of the following:

An ownership or investment interest in any entity or individual with which the Archdiocese or an Archdiocesan Affiliated Organization has a transaction or arrangement.

A compensation arrangement with the Archdiocese or an Archdiocesan Affiliated Organization or with any entity or individual with whom the Archdiocese and/or any Archdiocesan Affiliated Organization has a transaction or arrangement.

A potential ownership or investment interest in, or compensation arrangement with, any entity or individual with whom the Archdiocese or an Archdiocesan Affiliated Organization is negotiating a transaction or arrangement.

Compensation includes direct and indirect remuneration as well as gifts or favors that are substantial in nature.

In order to avoid any situation that may create or appear to create a conflict between his or her personal interests and the interests of the Archdiocese or any Archdiocesan Affiliated Organization, the following general guidelines shall be followed:

Church Personnel are not to take advantage of anyone to whom they are providing ministry or service in order to further their own personal, religious, political, business or economic interests.

Church Personnel are not to solicit, accept or give any personal gifts, favors, or things of value which could influence, or which could be construed as influencing any decision or obligation to the performance of one’s duties. Page 5 of 15

Except as set forth below, reasonable business-related entertainment and gifts from business relationships of not more than $50 are permitted, including traditional promotional events, as long as what is offered is consistent with usual business practice, cannot be construed as a bribe or a payoff, is not in violation of any law, and would not embarrass the Archdiocese, any Archdiocesan Affiliated Organization or the individual if disclosed publicly. If there is any reasonable doubt concerning the propriety of business-related entertainment and gifts, the matter should be discussed in advance with the individual’s supervisor or the Archdiocesan General Counsel.

It is to be noted that the restrictions contained in the preceding bullet are not intended to interfere with, or prevent, traditional arrangements, accommodations and relationships between bishops, priests, deacons and other religious, on the one hand, and those to whom they minister, on the other hand. In such cases, of course, reflective pastoral discretion is encouraged, especially in cases where the person to whom they minister may also be a supplier or vendor or potential supplier or vendor to the Archdiocesan Affiliated Organization with which the bishop, priest, deacon or other religious may be associated.

In no event should a gift be accepted from a supplier or vendor or potential supplier or vendor during, or in connection with, contract negotiations with such person.

In addition to the foregoing, an occasional meal or entertainment in the normal course of activities and business relations on behalf of the Archdiocese or any Archdiocesan Affiliated Organization, paid for by a business partner, is permitted provided that such hospitality is not excessive or unusual in nature.

It is never acceptable to solicit gifts, gratuities or business courtesies for the benefit of any Church Personnel, Immediate Family member or friend.

Church Personnel are not to knowingly take any action or make any statement that is intended to influence any undertaking of the Archdiocese or any Archdiocesan Affiliated Organization in such a way as to confer any benefit on such individual or anyone in the individual’s Immediate Family or business.

No Church Personnel serving on a board or committee of the Archdiocese or any Archdiocesan Affiliated Organization is to vote in connection with any decision that may constitute a conflict of interest; provided, however, that following a full and fair disclosure of such conflict of interest to the board or Page 6 of 15

committee, the other members of such board or committee may permit the disclosing person to participate in the discussion of the matter. In addition, nothing in this Code is intended to preclude any Church Personnel from serving on one or more boards or committees (whether or not they are associated with the Archdiocese or any Archdiocesan Affiliated Organization) provided that, when appropriate, full and fair disclosure of such multiple relationships is made to each such board and committee.

If any Church Personnel have any question about a possible conflict of interest, he or she is encouraged to talk with his or her supervisor and, if the circumstances require further interpretation, then with the Archdiocesan General Counsel.

The Archdiocesan General Counsel will be the authority to determine, in the exercise of his sole discretion, if a conflict of interest or an appearance of a conflict of interest exists.

General oversight of the Archdiocesan Administration of the Code of Conduct and Conflict of Interest Policy shall be the responsibility of the Audit Committee of the Archdiocesan Finance Council.

Political Activity

The Archdiocese encourages individual participation in civic affairs. However, Church Personnel are not to engage in political activities in a manner that may create the appearance that such activity is by or on behalf of the diocese. In this regard:

Funds of the Archdiocese or any Archdiocesan Affiliated Organization may not be used for political contributions, directly or indirectly, in support of any party or candidate.

Wherever lawful, however, the Archdiocese or any Archdiocesan Affiliated Organization may contribute to an occasional local initiative where the charitable works or purposes and goals of the Catholic Church are furthered. However, no such contribution can and must not favor a candidate nor support a political campaign. Contributions to local initiatives must obtain advance permission from the Vicar General and Moderator of the Curia of the Archdiocese and the Archdiocesan General Counsel.

Church Personnel are not to use any facilities, financial resources, or personnel of the Archdiocese or any Archdiocesan Affiliated Organization to endorse or oppose a candidate for public office.

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As interested citizens, Church Personnel are free to make lawful, individual, personal contributions to political candidates or campaigns but are in no way to do so in their capacity as employees, agents or representatives of the Archdiocese or any Archdiocesan Affiliated Organization.

Before any Church Personnel who are employees of the Archdiocese or any Archdiocesan Affiliated Organization seeks any elected or appointed political office, including a local position (such as school board member), he or she must discuss this matter with the Vicar General and Moderator of the Curia’s Office to ensure that no potential conflict of interest exists or appears to exist.

Disclosure

In connection with any actual or possible conflict of interest, an interested person must disclose the existence and nature of his or her financial interest and all material facts. In the event that an individual is uncertain whether an actual or potential conflict of interest exists, the individual should make disclosure of the circumstances that may give rise to an actual or potential conflict. Employees must make initial disclosure to their respective human resources office and clergy and volunteers should make initial disclosure to the Cabinet Secretary overseeing their Archdiocesan Affiliated Organization’s activities.

A Disclosure Questionnaire (see Exhibit A) will be filled out annually by all individuals subject to this Code in order to determine actual or possible conflicts of interest.

Reporting/Confidentiality/No Retaliation

All Church Personnel are required to report any reasonably perceived violation of: (a) federal, state or local laws, rules and/or regulations; (b) this Code; (c) the Archdiocesan Code of Ministerial Behavior; (d) Archdiocesan personnel policies; (e) Archdiocesan financial policies, including questionable or improper accounting or auditing matters; as well as gross mismanagement, waste, fraud, embezzlement, neglect of duty; and actions that threaten or are viewed as harmful to the health, safety and welfare of others and any other financial, legal or canonical concerns (hereinafter collectively referred to as “Concerns”).

Reports of Concerns should be made to the pastor, principal, Vicar General, Chancellor, and/or Archdiocesan General Counsel or may be made to the independent and confidential service described on the attached Exhibit B. Reports made to pastors and principals are to be reported to the Vicar General and Moderator of the Curia and the Chancellor. All Concerns are to be reported as soon as possible. Reports of Concerns should include all

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relevant information about the suspected act, including any material evidence that exists.

Anyone reporting a Concern must act in good faith and have reasonable grounds for believing the information disclosed is reliable. The act of making allegations that prove to be unsubstantiated, and that prove to have been made maliciously, recklessly, or with the foreknowledge that the allegations are false, will be viewed as a serious disciplinary offense and may result in discipline, up to and including dismissal from their position with the Archdiocese and/or the Archdiocesan Affiliated Organization, as the case may be. Such conduct may also give rise to other actions, including civil lawsuits.

Reports of Concerns, and investigations pertaining thereto, shall be kept confidential when permitted by law, consistent with the need to conduct an adequate investigation. Disclosure of reports of Concerns to individuals not involved in the investigation will be viewed as a serious disciplinary offense and may result in discipline, up to and including termination of the violator’s position with the Archdiocese and/or the Archdiocesan Affiliated Organization, as the case may be. Such conduct may also give rise to other actions, including civil lawsuits.

Church Personnel may confront an ethical issue where this Code or any other policy of the Archdiocese or Archdiocesan Affiliated Organization does not expressly provide an answer. Individuals should feel comfortable contacting the Archdiocesan General Counsel or using one of the other authorities described in this section.

All reported violations of this Code will be investigated by the appropriate authority and, where appropriate, reported, including actions taken, to the Audit Committee of the Finance Council.

The Archdiocese prohibits retaliation against Church Personnel who, in good faith, report or participate in the investigation of any Concerns. If any Church Personnel believe that they or others are the subject of retaliation for reporting Concerns or participating in an investigation, he or she must report it to the Vicar General and Moderator of the Curia, the Chancellor, and/or Archdiocesan General Counsel.

All Church Personnel must cooperate completely in any investigation relating to the Archdiocese or any Archdiocesan Affiliated Organization, and must be truthful at all times. Church Personnel may never interfere with or obstruct an investigation conducted by the Archdiocese or any Archdiocesan Affiliated Organization or any government agency. In addition, Church Personnel may never disclose or discuss an investigation with unauthorized persons.

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Legal Notice

This Code is not an employment contract Adherence to the standards of the Code is, however, a condition of continued employment or other service to the Archdiocese and its Archdiocesan Affiliated Organizations. This Code does not give Church Personnel rights of any kind, and may be changed by the Archdiocese at any time without notice.

Failure to comply with any responsibilities established by this Code may result in disciplinary action, up to and including termination of employment or service, as the case may be, as appropriate, and may also require restitution or reimbursement from the Church Personnel involved and referral of the matter to government authorities under the guidance of the Archbishop, the Vicar General and Moderator of the Curia, the Archdiocesan General Counsel or their respective delegate.

ROMAN CATHOLIC ARCHBISHOP OF BOSTON

By: Cardinal O'Malley, O.F.M., Archbishop of Boston

Date:______

By:

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Exhibit B

Reporting to EthicsPoint® of Violations of the Code of Conduct and Conflict of Interest Policy

The Archdiocese of Boston has a firm commitment to financial transparency and fiscal responsibility. In recent years we have strengthened this commitment in a variety of ways, from publishing annual reports, requiring parish audits, undergoing a consultative budget process and more. We have also provided numerous policies, procedures and training to assist our clergy, religious, employees, staff and volunteers to be better financial stewards.

Another important way that we can remain good stewards of the financial resources entrusted to us is to provide a confidential method of reporting suspected ethics violations, financial improprieties or other such matters to an independent third party. EthicsPoint® will assist the Archdiocese by providing that support, allowing our employees to report their concerns in a confidential manner.

Reports may be filed either via the internet at www.rcab.ethicspoint.com* or via one of EthicsPoint’s® trained specialists at 1-866-491-5283.

We pray that this may remind us all of our duty to be good stewards of the gifts that God has given to us.

*Attention: This website is hosted on EthicsPoint’s® secure servers and is not part of the Roman Catholic Archdiocese of Boston website or intranet.

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Acknowledgement of Receipt

Archdiocese of Boston Code of Conduct and Conflict of Interest Policy

This will acknowledge that I have personally received a copy of the Archdiocese of Boston Code of Conduct and Conflict of Interest Policy, and that I have read it, had it read to me, or listened to it on CD or tape. I understand the contents of the Code and agree to comply with them.

Date: Signature

Printed Name

Name of Employer or Name of Archdiocesan Affiliated Organization with which you are serving as an officer, Trustee, director, governor, member, volunteer, etc.:

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Exhibit A

Archdiocese of Boston

Code of Conduct and Conflict of Interest Policy

Disclosure Questionnaire

Name:

Name of Employer or Name of Archdiocesan Affiliated Organization with which you are serving as an employee, officer, Trustee, director, governor, member, volunteer, etc.:

Capitalized terms used herein and not defined herein shall have the respective meanings set forth in the Archdiocese of Boston Code of Conduct and Conflict of Interest Policy (the “Code”).

Describe your job or position:

1. Are you or any member of your Immediate Family an officer, director, trustee, partner (general or limited), employee or regularly retained consultant of any company, firm, organization or other entity that presently has business dealings with the Archdiocese or any Archdiocesan Affiliated Organization or which might reasonably be expected to have business dealings with the Archdiocese or any Archdiocesan Affiliated Organization in the coming year? If so, please list the name of the company, firm, organization or other entity, the position held and the nature of the business.

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2. Do you or does any member of your Immediate Family have a financial or personal interest in any company, firm, organization or other entity in which the Archdiocese or any Archdiocesan Affiliated Organization has a financial or other business interest?

3. Have you or any member of your Immediate Family accepted gifts, gratuities, lodging, dining or entertainment that might reasonably appear to influence your judgment or actions concerning the business of the Archdiocese or any Archdiocesan Affiliated Organization or were otherwise in violation of the Code ?

4. Do you have any other interest or role in any company, firm, organization or other entity where that interest or relationship might reasonably be expected to create an impression or suspicion among the public having knowledge of your acts that you engaged in conduct in violation of the Code or your trust as a bishop, priest, deacon, religious, seminarian, pastoral minister, administrator, lay employee, officer, director, trustee, governor, member or volunteer, as the case may be?

Signature:

Print name:

Date:

5 Page 15 of 15 CODE OF MINISTERIAL BEHAVIOR

for the

ARCHDIOCESE OF BOSTON

CONTENTS:

On Ministerial Behavior

1. Responsibilities

2. Code of Pastoral Conduct for Priests, Deacons, Pastoral Ministers, Administrators, Staff, Employees and Volunteers

- Conduct with Children and Youth - Sexual Conduct - Harassment - Conduct for Pastoral Counselors and Spiritual Directors - Confidentiality - Conflicts of Interest - Reporting Ethical or Professional Misconduct - Administration - Staff/Volunteer Well-being

3. Acknowledgement and Signature Sheet CODE OF MINISTERIAL BEHAVIOR

On Ministerial Behavior

Priests, deacons, pastoral ministers, administrators, staff, employees and volunteers in our parishes, religious communities, institutes, and organizations must uphold Christian values and conduct. The following Code of Pastoral Conduct provides a set of standards for conduct in pastoral situations.

1. Responsibility

- The public and private conduct of clergy, staff, and volunteers can inspire and motivate people, but it can also scandalize and undermine people’s faith. Clergy, staff, and volunteers must, at all times, be aware of the responsibilities that accompany their work. They must also know that God’s goodness and grace support them in their ministry.

- We have a responsibility to witness in all relationships the chastity appropriate to our state in life, whether celibate, married or single. We must avoid any covert or overt sexual behaviors with those for whom we have a professional or pastoral responsibility. This includes seductive speech or gestures as well as physical contact that sexually abuses, exploits or harasses another person. We are to provide safe environments in parishes, schools and institutions where children and others can be assured that their boundaries will not be violated.

- We should be aware of our own and other persons’ vulnerability, especially when working alone with another, and be particularly aware that we bear the greater responsibility for maintaining sexual boundaries in a pastoral relationship, for we hold the greater power. We must not initiate sexual behavior, and must refuse it when another invites or consents to it. We must give preference to the perspective and judgment of those who are vulnerable and dependent on us in order to determine whether touching would be an appropriate expression of pastoral care.

- We must show prudent discretion before touching another person, since we cannot control how physical touch will be received. We strive for greater self-awareness in order to recognize the sexual dynamics at work for us in pastoral relationships and to heed the warning signs in our lives that indicate when we are approaching boundary violations. We assume the full burden of responsibility for establishing and maintaining clear, appropriate boundaries in all our relationships with others.

- We should satisfy our needs for affection, intimacy, attraction, and affirmation outside the pastoral relationship. We should seek supervision, spiritual direction or other professional help to remain focused on our professional responsibilities and to hold firm to the sexual boundaries of the pastoral relationship. - We must intervene when there is evidence of or have reasonable cause to suspect that children are being abused in any way.

- We must report any suspected abuse or other violations of sexual conduct to the appropriate civil and ecclesial authorities, and then do what we can to see that justice is done for the victim, the offender, and the community from which the victim and minister come.

Responsibility for adherence to the Code of Pastoral Conduct rests with the individual. Clergy, staff, employees and volunteers who disregard this Code of Pastoral Conduct will be subject to remedial action by Archdiocese. Corrective action may take various forms—from a verbal reproach to removal from the ministry/employment—depending on the specific nature and circumstances of the offense and the extent of the harm.

2. Code of Pastoral Conduct For Priests, Deacons, Pastoral Ministers, Administrators, Staff, Employees and Volunteers

Conduct With Children and Youth

Clergy, staff, employees and volunteers working with children and youth shall maintain an open and trustworthy relationship between them and their adult supervisors. All must be aware of their own and others’ vulnerability when working alone with children. Always consider a team approach when working with children.

Physical contact with children can be misconstrued and should occur only when completely nonsexual and otherwise appropriate, and never in private. One-on-one meetings with a young person are best held in a public area, or if that is not appropriate, then the door to the room is left open, and someone on the parish staff is notified about the meeting.

Clergy, staff, employees and volunteers should refrain from the a) the illegal possession and/or illegal use of drugs and/or alcohol at all times, and b) the use of alcohol when working with youth. Adults should never buy alcohol, drugs, cigarettes, videos, or reading material that is inappropriate and give it to young people.

Clergy should not allow any young people to stay overnight in the cleric’s private accommodations or residence. Youth ministers and all adults should always meet with young people in areas that are visible and accessible. It is always a safe practice to have two adults in the area where youth are present or when driving children home.

Parish staff, employees and volunteers should not provide shared, private, or overnight accommodation for individual young people including, but not limited to, accommodations in any Church owned facility, private residence, hotel room, or any other place where there is no other adult supervision present. In rare, emergency situations, when accommodation is necessary for the health and well- being of the youth, the clergy, staff, or volunteer should take extraordinary care to protect all parties from the appearance of impropriety and from all risk of harm. Use a team approach to managing emergency situations.

Sexual Conduct

Clergy, staff, employees and volunteers must not, for sexual gain or intimacy, exploit the trust placed in them by the faith community. Clergy, religious, staff, and volunteers who are committed to a celibate lifestyle are called to be an example of celibate chastity in all relationships at all times.

Those who provide pastoral counseling or spiritual direction services must avoid developing inappropriate relationships with minors, other staff, or parishioners. Staff and volunteers must behave in a professionally supportive manner at all times. No clergy, employee, staff, or volunteer may exploit another person for sexual purposes.

Allegations of sexual misconduct should be taken seriously and reported to the appropriate civil and ecclesial authorities according to the policies and procedures of the Archdiocese of Boston. Clergy, staff, employees and volunteers should review and know the contents of the child abuse regulations and reporting requirements for the Commonwealth of Massachusetts and should follow those mandates.

Harassment

Clergy, staff, and volunteers must not engage in physical, psychological, written, or verbal harassment of staff, volunteers, or parishioners and must not tolerate such harassment by other Church staff or volunteers (reference the current Sexual Harassment Policy of the Archdiocese of Boston).

Clergy, staff, and volunteers shall provide a professional work environment that is free from physical, psychological, written, or verbal intimidation or harassment.

Harassment encompasses a broad range of physical, written, or verbal behavior including, but not limited to: physical or mental abuse, racial insults, derogatory ethnic slurs, unwelcome sexual advances or touching, sexual comments or sexual jokes, requests for sexual favors used as a condition of employment, or to affect other personnel decisions, such as promotion or compensation, and the display of offensive materials.

Harassment can be a single severe incident or a persistent pattern of behavior where the purpose or the effect is to create a hostile, offensive, or intimidating work environment.

Allegations of harassment should be taken seriously and reported immediately to the Secretary for Ministerial Personnel. The policies and procedures of the Archdiocese of Boston will be followed to protect the rights of all involved. Conduct for Pastoral Counselors and Spiritual Directors

Pastoral Counselors and Spiritual Directors are any clergy, staff, or volunteers who provide pastoral, spiritual, and/or therapeutic counseling services to individuals, families, or other groups. Pastoral Counselors and Spiritual Directors must respect the rights and protect the welfare of each person.

Pastoral Counselors and Spiritual Directors shall not step beyond their competence in counseling situations and shall refer clients to other professionals when appropriate, and should carefully consider the possible consequences before entering into a counseling relationship with someone with whom they have a pre-existing relationship (i.e., employee, professional colleague, friend, or other pre-existing relationship).

Pastoral Counselors and Spiritual Directors must never engage in sexual intimacies with the persons they counsel. This includes consensual and nonconsensual contact, forced physical contact, and inappropriate sexual comments. Nor should Pastoral Counselors and Spiritual Directors engage in sexual intimacies with individuals who are close to the client—such as relatives or friends of the client.

Pastoral Counselors and Spiritual Directors assume the full burden of responsibility for establishing and maintaining clear, appropriate boundaries in all counseling and counseling- related relationships. Physical contact of any kind (i.e., touching, hugging, holding) between Pastoral Counselors or Spiritual Directors and the persons they counsel can be misconstrued and should be avoided.

Sessions should be conducted in appropriate settings at all times. Sessions should not be held at places or times that would tend to cause confusion about the nature of the relationship for the person being counseled. Pastoral Counselors and Spiritual Directors should maintain a log of the times and places of sessions with each person being counseled.

Confidentiality

Information obtained in the course of sessions shall be confidential, except for compelling professional reasons or as required by law. If there is clear and imminent danger to the client or to others, the Pastoral Counselor or Spiritual Director may disclose only the information necessary to protect the parties affected and to prevent harm. Before disclosure is made, if feasible, the Pastoral Counselor or Spiritual Director should inform the person being counseled about the disclosure and the potential consequences.

Pastoral Counselors and Spiritual Directors should discuss the nature of confidentiality and its limitations with each person in counseling. Knowledge that arises from professional contact may be used in teaching, writing, homilies, or other public presentations only when effective measures are taken to absolutely safeguard both the individual’s identity and the confidentiality of the disclosures. While counseling a minor, if a Pastoral Counselor or Spiritual Director discovers a reasonable cause to believe that there is a serious threat to the minor’s health or welfare, including sexual abuse or neglect, or a disclosure is made indicating that the minor child is being abused in any way, the Pastoral Counselor or Spiritual Director should contact the appropriate civil and ecclesial authorities and make a report according to these Policies and Procedures.

These obligations are independent of the confidentiality of the Sacrament of Confession. Under no circumstances whatsoever can there be any disclosure of information received solely through the Sacrament of Confession.

Conflicts of Interest

Clergy, staff, employees and volunteers should avoid situations that might present a conflict of interest. Even the appearance of a conflict of interest can call integrity and professional conduct into question. Clergy, staff, employees and volunteers should disclose all relevant factors that potentially could create a conflict of interest.

Clergy, staff, employees and volunteers should inform all parties when a real or potential conflict of interest arises. Resolution of the issues must protect the persons involved in these relationships. No clergy, staff, or volunteer should take advantage of anyone to whom they are providing services in order to further their personal, religious, political, or business interests. Pastoral counselors should not provide counseling services to anyone with whom they have a business, professional, or social relationship. When this is unavoidable, the client must be protected. The counselor must establish and maintain clear, appropriate boundaries. When pastoral counseling or spiritual direction services are provided to two or more people who have a relationship with each other, the Pastoral Counselor or Spiritual Director must clarify with all parties the nature of each relationship, anticipate any conflict of interest, take appropriate actions to eliminate the conflict, and obtain from all parties written consent to continue services.

Conflicts of interest may also arise when a Pastoral Counselor’s or Spiritual Director’s independent judgment is impaired by prior dealings, becoming personally involved, or becoming an advocate for one (person) against another. In these circumstances, the Pastoral Counselor or Spiritual Director shall advise the parties that he or she can no longer provide services and refer them to another Pastoral Counselor or Spiritual Director.

Reporting Ethical or Professional Misconduct

Clergy, staff, employees and volunteers have a duty to report their own ethical or professional misconduct and the misconduct of others.

The Archdiocese requires that clergy, staff, employees and volunteers contact the Department of Social Services when they have knowledge or reasonable cause to suspect that a person under 18 years of age is being or has been abused or neglected, and to follow that oral report with a written report within forty-eight hours. Clergy, staff, employees and volunteers must hold each other accountable for maintaining the highest ethical and professional standards. When there is an indication of any illegal action by clergy, staff, or volunteers, the proper civil authorities should be notified immediately. Also notify the Secretary for Ministerial Personnel.

When an uncertainty exists about whether a situation or course of conduct violates this Code of Pastoral Conduct or other religious, moral, or ethical principles, consult with your supervisor, peers, others knowledgeable about ethical issues, or the appropriate Chancery office as listed above.

Administration

Employers and supervisors shall treat clergy, staff, and volunteers justly in the day-to-day administrative operations of their ministries. Personnel and other administrative decisions made by clergy, staff, and volunteers shall meet civil and canon law obligations and also reflect Catholic social teachings and this Code of Pastoral Conduct.

No clergy, staff, or volunteer shall use his or her position to exercise unreasonable or inappropriate power and authority.

Each volunteer providing services to children and youth must read and sign the Volunteer Code of Conduct before providing services.

Clergy, Staff or Volunteer Well-being

Clergy, staff, employees and volunteers have the duty to be responsible for their own spiritual, physical, mental, and emotional health. They should be aware of warning signs that indicate potential problems with their own spiritual, physical, mental, and/or emotional health, and seek help immediately whenever they notice behavioral or emotional warning signs in their own professional and/or personal lives.

Clergy, staff, and volunteers must address their own spiritual needs. Support from a Spiritual Director is highly recommended. Code of Conduct: Statement of Agreement

I promise to strictly follow the rules and guidelines in this Code of Conduct as a condition of my providing services to the children and youth of the Archdiocese of Boston.

I will: Treat everyone with respect, loyalty, patience, integrity, courtesy, dignity, and consideration.

Never be alone with children and/or youth at Church activities.

Use positive reinforcement rather than criticism, competition, or comparison when working with children and/or youth.

Maintain confidentiality in all matters related to normal parish business.

Comply with the mandatory reporting regulations of the Commonwealth of Massachusetts and with the Archdiocesan Policies and Procedures to report suspected child abuse. I understand that failure to report suspected child abuse to civil authorities is against the law.

Cooperate fully in any investigation of abuse of children and/or youth.

I will not: Touch or speak to a child and/or youth in a sexual or other inappropriate manner

Inflict any physical or emotional abuse such as striking, spanking, shaking, slapping, humiliating, ridiculing, threatening, or degrading children and/or youth.

Smoke or use tobacco products while engaging in activities with children and/or youth.

Accept or give gifts to children or youth without the knowledge of their parents or guardians.

Possess, or be under the influence of alcohol at any time while working with children and/or youth.

Possess, or be under the influence of illegal drugs at any time.

Use profanity in the presence of children and/or youth at any time.

I understand that as a person working with and/or ministering to children and/or youth, I am subject to a criminal history background check. My signature confirms that I have read this Code of Conduct and that as a person ministering to children and youth I agree to follow these standards. I understand that any action inconsistent with this Code of Conduct or failure to take action mandated by this Code of Conduct may result in my removal from ministry.

Printed Name: Signature/Date:

Witness Signature/Date

The suffering of those who have endured the evil of child sexual abuse is never far from my thoughts and is held deeply in my prayer. I again pledge myself to remain vigilant in making our faith environment a safe environment for all. Your active participation in these efforts is a source of strength and encouragement to me. Cardinal Seán P. O’Malley, Ofm Cap.

The dedicated efforts of lay leaders, parishioners, religious sisters and brothers, and clergy continue to build a culture of safety and protection for all children. Over the past thirteen years these efforts have included:

 Training over 140,000 children in personal safety skills.  Annually conducting over 55,000 CORI background checks for clergy, volunteers, educators, parish staff, school staff and athletic coaches.  Training 1,700 laity to serve as Child Abuse Prevention Team (CAP) members in parishes across the Archdiocese.  Educating 74,000 clergy, teachers, employees, and volunteers in child abuse prevention strategies.  Providing parents with resources pertaining to educating children in personal safety.  Outreach to clergy sexual abuse survivors and their families through the Office of Pastoral Support and Outreach.

Let the children come to me and do not prevent them; for the kingdom of God belongs to such as these. Luke 18:16

All employees of the Archdiocese of Boston are required to submit to a background screening, and to attend a Protecting God’s Children Training. Upcoming training schedule can be found at: BostonCatholic.org/ProtectingChildren OR email: [email protected]

ARCHDIOCESE OF BOSTON 66 BROOKS DRIVE BRAINTREE, MASSACHUSETTS 02184-3839

CRIMINAL OFFENDER RECORD INFORMATION (CORI) ACKNOWLEDGEMENT FORM

The Archdiocese of Boston, Office of Background Screening is registered under the provisions of M.G.L. c. 6, § 172 to receive CORI for the purposes of screening current and otherwise qualified prospective employees, subcontractors, or volunteers.

As a prospective or current employee, subcontractor, or volunteer, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to the Archdiocese of Boston, Office of Background Screening to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing the Archdiocese of Boston, Office of Background Screening with written notice of my intent to withdraw consent to a CORI check.

I also understand, that The Archdiocese of Boston, Office of Background Screening may conduct subsequent CORI checks within one year from the date this Form was signed by me. By signing below, I provide my consent to a CORI check and affirm that the information provided on Page 2 of this Acknowledgement Form is true and accurate.

SIGNATURE______DATE______

PLEASE CHECK ONE: Priest ⃞ Deacon ⃞ Seminarian ⃞ Paid Parish Staff ⃞ Pastoral Center ⃞ ⃞ Parish Volunteer – Ministering directly to children or having potential for interaction with children Parish Volunteer - Ministering Directly to Children or Having Potential for Interaction with Children ⃞ ⃞ Parish Volunteer – Ministering to elderly Parish Volunteer – Ministering to Elderly ⃞ ⃞ Priest ⃞ Deacon ⃞ Seminarian ⃞ Paid Parish Staff

Educator ⃞ School Staff ⃞ School Volunteer ⃞ Contractor ⃞ ⃞ Educator ⃞ School Staff ⃞ School Volunteer ⃞ Contractor ⃞ Pastoral Center

PLEASE CHECK ONE: ⃞ Employee - Position/Title:______⃞ Volunteer - Position/Ministry:______

PLEASE CHECK ONE: NEW ⃞ a FY20 NEW CORI – (I did not complete a CORI last year.) RENEWAL ⃞ a FY20 RENEWAL CORI – (I did complete a CORI last year.)

NAME OF AGENCY/PARISH/SCHOOL SUBMITTING CORI CITY/TOWN

Page 1 of 2 FY2020

SUBJECT INFORMATION The fields marked with an asterisk (*) are required by the Massachusetts Department of Criminal Justice Information Services (DCJIS) for CORI processing.

* First Name:______Middle Initial:______

* Last Name:______Suffix (Jr. Sr., etc.):______

* Former Last Name 1/Maiden Name: ______

* Former Last Name 2: ______

* Former Last Name 3: ______

* Former Last Name 4:______

* Date of Birth (MM/DD/YYYY): ______Place of Birth:______

* Last SIX digits of Social Security Number: ______‐‐ ______☐ No Social Security Number

Sex: ______Height: _____ ft. _____ in. Eye Color: ______Race:______

*Driver’s License or ID Number: ______*State of Issue:______

Father’s Full Name:______

Mother’s Full Name:______

CURRENT ADDRESS

* Street Address:______

* Apt. # or Suite: ______*City: ______*State: ______*Zip:______

SUBJECT VERIFICATION To be completed by Employee/Ministry Leader

The above information was verified by reviewing the following form(s) of government‐issued identification:

______

VERIFIED BY: (Employee/Ministry Leader)

Print Name ______

Signature______Date______

Page 2 of 2 FY2020

SCHOOL ELECTRONIC USE POLICY TEMPLATE [enter the school name]

Abstract This document provides guidelines for the use of information technology resources at [enter the school name]

[enter the school Address] [enter the school email address] SCHOOL ELECTRONIC USE POLICY

Dear Reader,

The RCAB Department of Information Technology is pleased to share with you this document to help your school establish an electronic use policy. Schools are just as exposed to the risks of Information Technology (IT) resource damage, data loss or theft, as are other businesses and organizations. A clear and well communicated electronic use policy is one part of an effective approach to securing IT resources and data (see figure below). All school staff should be aware of the potential risks and expectations of the use of IT.

This document has been formatted as a template. Highlighted text indicates parts that need to be filled in. Comments are included only to help clarify areas of the document; these can be deleted after reading. Not all sections of the document will necessarily apply in every school situation; these can be modified or removed as appropriate.

Questions regarding the template document can be emailed to: [email protected].

From the desk of The RCAB Information Technology Department 66 Brooks Drive, Braintree MA. 02184 [email protected]

Contents

STATEMENT ...... 1 APPLICABILITY ...... 1 TERMINOLOGY ...... 1 GENERAL POLICIES AND GUIDELINES ...... 2 Ownership ...... 2 Monitoring ...... 2 Sexual or Other Harassment ...... 2 Copyrighted Materials ...... 3 Solicitation ...... 3 Professionalism ...... 3 EMAIL ...... 3 Microsoft Office 365...... 4 PASSWORDS...... 4 INTERNET ACCESS ...... 5 VIRUS DETECTION ...... 5 A Special note on Thumb Drives ...... 6 UNAUTHORIZED HARDWARE ...... 6 A Special note for Visitors ...... 7 UNAUTHORIZED SOFTWARE AND APPLICATIONS ...... 7 UNAUTHORIZED USE ...... 7 CONFIDENTIALITY...... 7 PERSONAL INFORMATION ...... 8 BACKUPS ...... 9 LOST OR STOLEN DEVICES ...... 9 QUESTIONS ...... 9 DOCUMENT HISTORY...... 10 USER ACKNOWLEDGEMENT ...... 11

SCHOOL ELECTRONIC USE POLICY

STATEMENT

This policy sets out guidelines, processes and expectations for use of information technology resources, including, without limitation, computers and information systems, networks, data, the internet, and all modes of electronic transmission and communication.

APPLICABILITY

This policy applies to all school staff members (lay and clergy), volunteers, interns, contractors, vendors and visitors. This policy applies to all school offices and locations that utilize school information technology resources. This includes the [list school locations as appropriate]. This policy does not apply to [list any exclusions as appropriate]. [enter the school name] reserves the right, within its sole discretion, to limit or deny access to School Systems. Any violation of the School Electronic Use Policy (“this policy”) by staff or interns is grounds for discipline up to and including termination of employment or other appropriate penalties. Any violation of this policy by contractors or vendors may be deemed to be a breach of contractual arrangements. Any violation of this policy by volunteers or visitors is grounds for the immediate removal of access to all School Systems and information technology resources, including, without limitation, internet access.

TERMINOLOGY

“School” – refers to [enter the school name and address]. “School Systems” - refers to all systems, services, networks, devices (including, without limitation, servers, desktop computers, laptops, tablets, cellular phones, and telephones, and Voice over IP phones), email, internet access, file storage (including, without limitation, network storage and portable storage devices such as USB thumb and other drives) owned, leased, licensed or managed by the School. “User or Users” – refers to anyone using School Systems. “Data” – refers to all electronically transmitted or stored data or information, including, without limitation, documents, databases, voice mails, text messages, emails and their attachments, videos, sound files, graphic and geographic spatial data files. Data also includes, without limitation, software and programs designed to operate on any School Systems, including, mobile devices. “Software” – is a general term referring to computer programs and applications designed to be

SCHOOL ELECTRONIC USE POLICY installed on computers or mobile devices with the express purpose of supporting an activity. Examples include business applications such as Microsoft Word, Adobe Reader, etc. Software need not have a user interface with which a User interacts with the software but may run “in the background”. “Unauthorized equipment” – refers to any equipment, including, without limitation, desktop computers, laptops, routers, switches, wireless access points (Wi-Fi), external hard-drives, NAS Drives, etc., that has not been purchased or authorized by the School’s [enter appropriate business role, e.g., Business Manager] (the “[enter abbreviation, e.g., BM”]). It also refers to any other equipment that has not been explicitly approved by the [enter abbreviated name, e.g., BM] to operate on the School Systems. “Hacking” – refers to using a computer to gain unauthorized access to Data or computer resources. “RCAB” – refers to the Roman Catholic Archbishop of Boston, a Corporation Sole.

GENERAL POLICIES AND GUIDELINES

Ownership All School Systems and Data are the property of the School and are provided to staff and other Users to help facilitate the work of the School. Neither the Data nor the School Systems are the private property of any User. The School reserves the right to monitor and physically inspect all or any part of the School Systems at any time, without notice to an affected User.

Monitoring School Systems monitoring may include, among other activities: • Monitoring which websites Users visit, • Reviewing materials and Data uploaded or downloaded by Users to the internet or to Office 365 accounts, box accounts, etc., • Reviewing email sent and received by Users.

Sexual or Other Harassment RCAB policies against sexual harassment or any other form of harassment, including, without limitation, the RCAB equal opportunity policy, apply fully to all School Systems and Data. Any violation of those policies is grounds for discipline up to and including termination of employment or other appropriate penalties. • No Data may be created, stored, or transmitted if it contains fraudulent, harassing, intimidating, hostile, or offensive material concerning race, color, religion, sex, age, national origin, disability or any other classification protected by law. • Any Data or information received that is deemed to be fraudulent, harassing, 2

SCHOOL ELECTRONIC USE POLICY

intimidating, hostile, or offensive concerning race, color, religion, sex, gender, age, national origin, disability or any other classification protected by law should be deleted. If receipt of such types of information persists, this should be reported to the [enter appropriate business role]. • Any violations of this policy should be reported immediately to the Director of Human Resources at the RCAB.

Copyrighted Materials School Systems shall not be used to copy, store, send or receive copyrighted materials or Data, trade secrets, proprietary information, or similar third-party materials without prior authorization from the owner of such materials. If uncertain about whether Data is copyrighted, proprietary, or otherwise inappropriate for transfer, a User should resolve all doubts in favor of not transferring the information. • Users are responsible for complying with copyright law and applicable license agreements that may apply to Data and to any systems on which that Data is utilized. • No User may agree to a license or download any Data for which a fee is charged without first obtaining the written permission from the [enter appropriate business role].

Solicitation School Systems may not be used to solicit for political causes, commercial enterprises, outside organizations, personal fund raising, personal reasons, or other non-job-related solicitations.

Professionalism Users must conduct themselves in a courteous and professional manner when utilizing School Systems. All Data and communications are to exhibit Catholic values of faith, service, and integrity. Please note that Data, including, without limitation, contents of emails and documents, are highly transportable and may be accessed and read by unintended recipients.

Every User with a School email address is responsible for using the email system properly and in accordance with this policy. • The email system and all emails and attachments sent, received, or stored (whether locally or elsewhere) are the property of the School. • Use of the School email system for personal purposes is not permitted. The School email system is for business purposes only. • School business email should not be forwarded to personal email accounts or any non- School systems without permission from [enter appropriate business role], except in the

SCHOOL ELECTRONIC USE POLICY

ordinary course of performing duties on behalf of the School. • School business email should not be forwarded in bulk to personal email accounts or any non-School systems without permission from the [enter appropriate business role]. • Users have no right of personal privacy in their use of the email system. Use of a User password does not create any rights to privacy. • The School may monitor, access, retrieve, and delete any Data created, stored, sent or received over the email system, for any reason and without the permission of any User. • The School reserves the right to change User passwords for any reason to enable account access. • Even though the School has the right to retrieve and read any email messages, those messages should still be treated as confidential by other staff members and handled accordingly. Staff members are not authorized to retrieve, read, forward, or print any e- mail messages that are not intended to be sent to them. If a staff member inadvertently or incorrectly receives an email message that he or she was not intended to receive, please contact the sender to alert him or her of the error and delete the email. • To ensure optimal systems performance and to minimize maintenance costs, Users should delete outdated or unnecessary emails and computer files in compliance with any applicable document or data retention policies. • All staff members should include contact information on the bottom of each e-mail sent, including e-mail address, street address, job title and direct dial telephone number.

Microsoft Office 365 Every User with a School Office 365 account is responsible for using the system properly and in accordance with this policy. The Microsoft Office 365 system is administered and managed by the School and is considered one of the School Systems. All acceptable use policies explicitly noted in this policy, including, without limitation, those listed in the section on ‘Email’ apply equally to the use of the School Office 365 system.

PASSWORDS

Users are expected to protect passwords used to access School Systems. Users are not to keep passwords in a manner where others are able to readily see or access them. This includes on sticky notes, under keyboards, etc. Passwords should not be shared. Users should lock their computer (CTRL-ALT-DEL) when stepping away from their desks. The School offices and other related locations, host visitors, groups, as well as other facility maintenance personnel, etc., so due diligence in protecting access to School Systems is expected 4

SCHOOL ELECTRONIC USE POLICY of all Users.

INTERNET ACCESS

Access to the internet is provided to all staff for the express purpose of accomplishing job tasks and responsibilities. • Use of the internet for non-business purposes is limited to de minimus use only. • Use of the internet to access personal webmail including Hotmail, Outlook, Gmail, iCloud, Yahoo, Verizon, Comcast, etc., is not permitted. • Personal email should only be done on personally owned devices such as smartphones or tablets utilizing the School guest Wi-Fi only. • Computer resources should not be wasted. Examples of waste include: o Playing computer games, o Streaming non-work related videos, e.g., YouTube or audio files, e.g., Pandora, o Unnecessary printing. • User’s personal Data, including, without limitation, documents, photographs and videos, should not be stored on any School Systems. • Posting of Data on the internet requires approval from [enter appropriate business role]. Once approved posted Data should: o Contain all proper copyright and trademark consents and include required notices, as appropriate. o Comply with all applicable laws. • The School may use software to help block inappropriate websites. Nonetheless, the School cannot protect Users against the existence or receipt of material that may be offensive to them. If a User encounters inappropriate material, he/she should immediately close the site and report the incident to [enter appropriate business role]. • The School may impose stricter internet filtering policies at any time without notice.

VIRUS DETECTION

Files obtained from sources outside the School, including, without limitation, files brought from home; files downloaded from the internet; files attached to emails; and files provided by contractors or vendors, may contain malicious viruses that could cause significant damage to School Systems. • Users should not download files from the internet, open email attachments from unknown senders, or use storage devices from non-School sources, without first scanning the 5

SCHOOL ELECTRONIC USE POLICY

material with virus checking software. • Users should familiarize themselves with best practices for handling emails from unknown sources or when browsing the internet. Clicking on a suspect link may open the door to a computer virus that could quickly spread and damage the network. • If a User suspects that a virus has been introduced into the network, he/she must notify [enter appropriate business role] immediately. • For help with virus scanning please contact [enter appropriate business role].

A Special note on Thumb Drives Thumb drives (USB memory sticks or flash drives) are notorious for transmitting viruses. • Only School provided thumb drives should be used on School Systems. • Use all thumb drives only with extreme care and due caution and ideally not at all. • Do not use thumb drives provided by non-School sources including, without limitation, those picked up at conferences and vendor exhibits. • Do not plug in any “found” USB drives just to see what is on them – hand these in to [enter appropriate business role]. • Do not open any files on a School provided thumb drive without first scanning the drive with a virus checking software.

UNAUTHORIZED HARDWARE

The School provides all necessary computer equipment to School staff members and other Users. No User is authorized to use equipment purchased through an outside vendor without first consulting with [enter appropriate business role], nor is any User permitted to connect unauthorized equipment (see definition above) to the School network either at the School office or at remote office locations. The School does not support Bring Your Own Device (BYOD), which means that personal computers or other computing devices purchased by individuals cannot be connected to the School network. Notwithstanding the foregoing, under very limited conditions, stringent controls, and prior written approval from the [enter appropriate business role], some non-School devices may connect to the School network. In these cases the School may install various software on the device and the User will need to agree to allow [enter appropriate business role] to completely wipe the contents of the device as and when deemed necessary and without the User’s prior approval. This may result in personal Data or programs being lost and unrecoverable. Users are welcome to join their personal devices to the School guest Wi-Fi network. [This assumes that there is a School guest Wi-Fi network that is separate and distinct from the School business network.] 6

SCHOOL ELECTRONIC USE POLICY

A Special note for Visitors Visitors, contractors, vendors and other non-School staff are not permitted to “unplug” any School devices or “plug-in” any non-School devices to Ethernet jacks located in any of the School offices and facilities. Visitors, contractors, and vendors needing to “plug-in” to an Ethernet jack are required to contact the [enter appropriate business role] before doing so to obtain permission. Note that computers, laptops and other hardware may be inspected or scanned. This does not guarantee that permission will be provided. Visitors to the School office are welcome to use the “guest” wireless network. This resource is provided as a service and can be utilized at the User’s risk. The School assumes no responsibility for any damage that may directly or indirectly occur to any hardware, software, or Data when using this service. The School makes every effort to provide comprehensive, high quality guest Wi-Fi. However, there is no guarantee of availability or dependability, especially when hosting large groups. Any questions or concerns can be directed to the [enter appropriate business role].

UNAUTHORIZED SOFTWARE AND APPLICATIONS

Software downloaded from the internet and installed on computers may cause significant damage to computers and may quickly infect a network. Viruses, malware, and tools designed to steal Data can inadvertently be introduced and create problems impacting all Users. This can occur even if the software appears to be from a reputable vendor or website. Because of this risk, Users should first request permission to install software on network attached computers and laptops from [enter appropriate business role].

UNAUTHORIZED USE

Users are expressly prohibited from pirating software, stealing passwords, Hacking other computers, either local to the network or not, attempting to gain access to files, folders, computer resources, including firewalls, network equipment and servers, to which access has not been provided as part of their daily duties or access expressly approved, bulk emailing not in accordance with User’s job responsibilities, or any unlawful activities or those not in accordance with the acceptable use policy.

CONFIDENTIALITY

All School Data is considered confidential. Therefore, Users must treat all matters accordingly. • No School Data may be removed, copied or forwarded to any non-School system without permission from [enter appropriate business role], except in the ordinary course of performing duties on behalf of the School. 7

SCHOOL ELECTRONIC USE POLICY

• No School Data may be forwarded or disclosed to anyone, except where required for an authorized purpose. • Users may not disclose any confidential information, purposefully or inadvertently through casual conversation, to any unauthorized person inside or outside the School. • Staff members who are unsure about the confidential nature of specific information should ask [enter appropriate business role] for clarification.

PERSONAL INFORMATION

Although all Data are considered confidential unless otherwise defined, some Data are considered to be Personal Information and are protected by law. Special care needs to be taken when handling or storing Personal Information. Personal Information or “PI” comprises an individual’s first name and last name or first initial and last name in combination with any one or more of the following data elements that relate to such person: (a) Social Security number; (b) driver's license number or state-issued identification card number; or (c) financial account number, or credit or debit card number, with or without any required security code, access code, personal identification number or password, that would permit access to a resident’s financial account; provided, however, that “Personal Information” shall not include information that is lawfully obtained from publicly available information, or from federal, state or local government records lawfully made available to the general public. Without limiting the definitions noted above, if you have access to, see, or work with PI you are required to follow the RCAB Personal Information Security Policy (effective January 1, 2018). Copies of this policy are available from the RCAB Human Resources Department.

FAMILY EDUCATION RIGHTS AND PRIVACY ACT (FERPA)

FERPA is a Federal law that protects the privacy of student records. This law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. To learn more about FERPA and the rights of parents and “eligible students” review online resources including: https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html https://studentprivacy.ed.gov

SCHOOL ELECTRONIC USE POLICY

BACKUPS

The School utilizes backups to ensure that business documents and files are not lost due to a significant IT event or mishap. All files stored on [enter details as appropriate] are routinely backed up and sent off-site for safe keeping. The following devices are NOT backed up and should they malfunction or be subject to a virus, files stored on these devices would not be recoverable: • [enter details as appropriate, e.g., desktop computer C drives, Box accounts, etc.] All business documents and files should be stored on [enter details as appropriate] to ensure they are included in nightly backups. In certain situations, virus infected devices will be wiped in their entirety, meaning that all information stored on the device will be unrecoverable.

LOST OR STOLEN DEVICES

If any School device, including a desktop, laptop, tablet, mobile device, or any other device owned or managed by the School is lost or stolen, this needs to be reported immediately to the [enter appropriate business role] and the RCAB Risk Management Office.

QUESTIONS

Any questions about this policy should be addressed to [enter appropriate business role].

SCHOOL ELECTRONIC USE POLICY

DOCUMENT HISTORY

Version Date Author Description 1.0 07/13/2017 Peter Bujwid, RCAB IT Department Original RCAB Roman Catholic Archdiocese of Boston template version 66 Brooks Drive, Braintree, MA. 02184 [email protected] 1.1 3/15/2019 Peter Bujwid, RCAB IT Department Template modified for use by Catholic Schools.

SCHOOL ELECTRONIC USE POLICY

USER ACKNOWLEDGEMENT

I acknowledge that I have received, read, and understand the [enter the school name and address] (School) Electronic Use Policy. I understand that the School has the right to change these policies from time to time. I acknowledge that at times the School may test policy compliance and understanding without notice. I also understand and agree that any violation of these policies may lead to disciplinary action, up to and including termination of employment by the School or loss of business relationships with the School, with or without notice.

 I am an employee, intern, or volunteer, working for the School  I am a contractor or vendor working for the School (also complete section 2)

Signature

Name (please print)

Date

Section 2: This section is for vendors and contractors:

Name of Company or Affiliation

Address Phone Number

Signed User acknowledgements should be returned to [enter appropriate business role].

To: All Archdiocese Staff (Lay, Clergy, Non-Ordained Religious, Volunteer)

Date: February 2020

Subject: SEXUAL HARASSMENT POLICY DISTRIBUTION

I. POLICY STATEMENT:

In keeping with our belief in the inherent dignity of each and every individual person, it is the goal of the Archdiocese of Boston to provide a work environment where all persons are treated with respect. Consistent with this goal, it is the policy of the Archdiocese of Boston to promote a workplace that is free from sexual harassment.

Sexual harassment occurring in the workplace or in any setting in which staff members may find themselves in connection with their employment or assignment is unlawful, demeaning to the individual, and will not be tolerated. Similarly, retaliation against an individual who has, in good faith, raised a concern about sexual harassment, or against any individual cooperating with a sexual harassment complaint investigation, is also unlawful and will not be tolerated.

To maintain a workplace free from sexual harassment, this policy includes definitions of sexual harassment, examples of inappropriate conduct and a process for reporting complaints of sexual harassment. Additionally, because the Archdiocese takes allegations of sexual harassment seriously, we will respond promptly to such complaints and, where it is determined that such inappropriate conduct has occurred, we will act promptly to eliminate the conduct and impose such corrective action as is necessary, including disciplinary action where appropriate.

Please note that while this policy promotes a workplace that is free of sexual harassment, the policy is not designed or intended to limit our authority to discipline or take remedial action for any workplace conduct which the Archdiocese deems unacceptable, regardless of whether or not the conduct meets the definition of sexual harassment.

II. DEFINITIONS:

II.A. Sexual Harassment:

Massachusetts’ legal definition for sexual harassment is as follows: “sexual harassment” means unwelcome sexual advances, requests for sexual favors, and verbal or physical conduct of a sexual nature when: (a) Submission to or rejection of such advances, requests or conduct is made either explicitly or implicitly a term or condition of employment/assignment or as a basis for employment/assignment decisions; or

1 February 2020 (b) Such advances, requests or conduct have the purpose or effect of unreasonably interfering with an individual’s work performance by creating an intimidating, hostile, humiliating or sexually offensive work environment.

Under these definitions, direct or implied requests by a superior for sexual favors in exchange for actual or promised position benefits such as favorable reviews, salary increases, promotions, increased benefits, or continued employment constitutes sexual harassment.

The legal definition of sexual harassment is broad and in addition to the above examples, other unwelcome sexually oriented conduct that has the effect (whether it is intended or not) of creating a work place that is sexually hostile, offensive, intimidating or humiliating to male or female staff members, may also constitute sexual harassment.

While it is not possible to list all those additional circumstances that may constitute sexual harassment, the following are some examples of conduct which, if unwelcome, may constitute sexual harassment depending on the totality of the circumstances including the severity of the conduct and its pervasiveness:

• Unwelcome sexual advances – whether they involve physical touching or not; • Sexual epithets, jokes, written or oral references to sexual conduct; gossip regarding one’s sex life; sexually oriented comments about an individual’s body; comments about an individual’s sexual activity, deficiencies, or prowess; • The display of sexually suggestive objects, pictures, cartoons, etc.; • Sexually explicit voice mail, e-mail, graphics, downloaded material or websites in the workplace; • Unwelcome leering, whistling, brushing against the body, sexual gestures, suggestive or insulting comments; • Inquiries into one’s sexual experiences; and • Discussion of one’s sexual activities.

II.B. Retaliation/Retaliatory Action:

All staff members should take special note that retaliation against an individual who has, in good faith, complained about sexual harassment, and retaliation against individuals for cooperating or assisting with an investigation of a sexual harassment complaint is unlawful and will not be tolerated.

For the purpose of this policy, the terms “retaliation” and retaliatory action” can include, but are not limited to (a) the denying or withholding of any tangible job benefits, e.g., promotions, increases in compensation, benefits, and requested transfers or (b) the assessment of an adverse employment decision against the staff member, e.g., job demotion, unfavorable job evaluation, withholding of a favorable recommendation, undesired transfer or change in work schedule, or other unfavorable change in the terms and conditions of employment. Retaliation can be any action that produces an injury or harm that a reasonable employee would find materially adverse and/or which might dissuade a reasonable employee from making or supporting a complaint of harassment. In addition to actions that are materially disadvantageous, retaliation also includes threats, intimidation, coercion, or other interference with employment directed toward a person because the person complained of harassment or assisted or encouraged another who complained of harassment.

2 February 2020

III. PROCESS FOR COMPLAINTS OF SEXUAL HARASSMENT:

If you feel you have been subjected to sexual harassment, you should report the matter, either orally or in writing, to your immediate supervisor, agency director, parish school principal, parish business manager or pastor. Central Administrative Offices supervisory personnel who receive a complaint should, in turn, promptly inform their agency director. Parish supervisory personnel (parochial vicars, school principals, DREs, business managers, directors of music, youth ministry coordinators, etc.) should promptly inform the pastor of any such complaints. Upon receipt of a complaint, it is the responsibility of the agency director or pastor to promptly notify Human Resources so that an appropriate investigation may be conducted.

If, for any reason, you feel that you cannot report the matter to your immediate supervisor, agency director, school principal, parish business manager or pastor, you should report the incident to Jim DiFrancesco, Director of Human Resources, Archdiocese of Boston, 66 Brooks Drive, Braintree, MA 02184, (617) 746-5829 or Joyce Contrucci, Human Resources Generalist, Archdiocese of Boston, 66 Brooks Drive, Braintree, MA 02184, (617) 779-3886. These individuals are available to discuss any concerns you may have and to provide information to you about our Policy on Sexual Harassment and our complaint process.

IV. SEXUAL HARASSMENT INVESTIGATION:

Upon receipt of a complaint, we will promptly investigate the allegation in a fair and expeditious manner. The investigation will be conducted in such a way as to maintain confidentiality to the extent practicable under the circumstances. Our investigation will include:

• A private interview with the person filing the complaint • Interview(s) with any/all witnesses • An interview with the person alleged to have committed sexual harassment

Upon completion of the investigation, we will, to the extent appropriate inform the person filing the complaint and the person alleged to have committed the conduct of the results of that investigation.

If it is determined that inappropriate conduct has occurred, we will act promptly to eliminate the offending conduct, and where it is appropriate, we will also impose disciplinary action.

V. DISCIPLINARY ACTION:

If it is determined that inappropriate conduct has been committed by a staff member, we will take such action as is appropriate under the circumstances. Such action may range from counseling to termination of employment and/or assignment and may include such other forms of disciplinary action as we deem appropriate under the circumstances.

VI. STATE AND FEDERAL REMEDIES:

In addition to the Archdiocesan Sexual Harassment Policy, if you believe you have been subjected to sexual harassment, you may also file a formal complaint with either or both government agencies listed below:

The United States Equal Employment Opportunity Commission (“EEOC”) www.eeoc.gov John F. Kennedy Federal Building 475 Government Center Boston, MA 02203 Phone: 1-800-669-4000 TTY: 1-800-669-6820

3 February 2020

The Massachusetts Commission Against Discrimination (“MCAD”) www.mass.gov/mcad One Ashburton Place, Room 601 Boston, MA 02108 Phone: (617) 994-6000 TTY: 617-994-6196

Using the complaint process within the Archdiocese does not prohibit you from filing a complaint with these government agencies. Both agencies have a short time limitation (from the time of alleged harassment) in which you must file a formal complaint/claim: EEOC – 300 days; MCAD – 300 days.

4 February 2020 Employment Eligibility Verification USCIS Department of Homeland Security Form I-9 OMB No. 1615-0047 U.S. Citizenship and Immigration Services Expires 10/31/2022

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)

Address (Street Number and Name) Apt. Number City or Town State ZIP Code

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number - -

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.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions) QR Code - Section 1 Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: Do Not Write In This Space An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number: OR 2. Form I-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance:

Signature of Employee Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator Today's Date (mm/dd/yyyy)

Last Name (Family Name) First Name (Given Name)

Address (Street Number and Name) City or Town State ZIP Code

Employer Completes Next Page

Form I-9 10/21/2019 Page 1 of 3 Employment Eligibility Verification USCIS Department of Homeland Security Form I-9 OMB No. 1615-0047 U.S. Citizenship and Immigration Services Expires 10/31/2022

Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status Employee Info from Section 1

List A OR List B AND List C Identity and Employment Authorization Identity Employment Authorization Document Title Document Title Document Title

Issuing Authority Issuing Authority Issuing Authority

Document Number Document Number Document Number

Expiration Date (if any) (mm/dd/yyyy) Expiration Date (if any) (mm/dd/yyyy) Expiration Date (if any) (mm/dd/yyyy)

Document Title

QR Code - Sections 2 & 3 Issuing Authority Additional Information Do Not Write In This Space

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions)

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name

Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) B. Date of Rehire (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below. Document Title Document Number Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Form I-9 10/21/2019 Page 2 of 3 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED

Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.

LIST A LIST B LIST C Documents that Establish Documents that Establish Documents that Establish Both Identity and Identity Employment Authorization Employment Authorization OR AND

1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a 1. A Social Security Account Number State or outlying possession of the card, unless the card includes one of 2. Permanent Resident Card or Alien United States provided it contains a the following restrictions: Registration Receipt Card (Form I-551) photograph or information such as (1) NOT VALID FOR EMPLOYMENT name, date of birth, gender, height, eye 3. Foreign passport that contains a color, and address (2) VALID FOR WORK ONLY WITH temporary I-551 stamp or temporary INS AUTHORIZATION I-551 printed notation on a machine- 2. ID card issued by federal, state or local (3) VALID FOR WORK ONLY WITH readable immigrant visa government agencies or entities, DHS AUTHORIZATION provided it contains a photograph or 4. Employment Authorization Document information such as name, date of birth, 2. Certification of report of birth issued that contains a photograph (Form gender, height, eye color, and address by the Department of State (Forms I-766) DS-1350, FS-545, FS-240) 3. School ID card with a photograph 5. For a nonimmigrant alien authorized 3. Original or certified copy of birth to work for a specific employer 4. Voter's registration card certificate issued by a State, because of his or her status: county, municipal authority, or 5. U.S. Military card or draft record territory of the United States a. Foreign passport; and bearing an official seal b. Form I-94 or Form I-94A that has 6. Military dependent's ID card the following: 7. U.S. Coast Guard Merchant Mariner 4. Native American tribal document Card (1) The same name as the passport; 5. U.S. Citizen ID Card (Form I-197) and 8. Native American tribal document (2) An endorsement of the alien's 6. Identification Card for Use of nonimmigrant status as long as 9. Driver's license issued by a Canadian Resident Citizen in the United that period of endorsement has government authority States (Form I-179) not yet expired and the proposed employment is not in For persons under age 18 who are 7. Employment authorization conflict with any restrictions or unable to present a document document issued by the Department of Homeland Security limitations identified on the form. listed above: 6. Passport from the Federated States 10. School record or report card of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with 11. Clinic, doctor, or hospital record Form I-94 or Form I-94A indicating nonimmigrant admission under the 12. Day-care or nursery school record Compact of Free Association Between the United States and the FSM or RMI

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form I-9 10/21/2019 Page 3 of 3 Instructions for Form I-9, Employment Eligibility Verification USCIS Form I-9 Department of Homeland Security OMB No. 1615-0047 U.S. Citizenship and Immigration Services Expires 10/31/2022

Anti-Discrimination Notice. It is illegal to discriminate against work-authorized individuals in hiring, firing, recruitment or referral for a fee, or in the employment eligibility verification (Form I-9 and E-Verify) process based on that individual's citizenship status, immigration status or national origin. Employers CANNOT specify which document(s) the employee may present to establish employment authorization. The employer must allow the employee to choose the documents to be presented from the Lists of Acceptable Documents, found on the last page of Form I-9. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. For more information, contact the Immigrant and Employee Rights Section (IER) in the Department of Justice's Civil Rights Division at https://www.justice.gov/ier.

What is the Purpose of This Form?

Employers must complete Form I-9 to document verification of the identity and employment authorization of each new employee (both citizen and noncitizen) hired after November 6, 1986, to work in the United States. In the Commonwealth of the Northern Mariana Islands (CNMI), employers must complete Form I-9 to document verification of the identity and employment authorization of each new employee (both citizen and noncitizen) hired after November 27, 2011.

General Instructions

Both employers and employees are responsible for completing their respective sections of Form I-9. For the purpose of completing this form, the term “employer” means all employers, including those recruiters and referrers for a fee who are agricultural associations, agricultural employers, or farm labor contractors, as defined in section 3 of the Migrant and Seasonal Agricultural Worker Protection Act, Public Law 97-470 (29 U.S.C. 1802). An “employee” is a person who performs labor or services in the United States for an employer in return for wages or other remuneration. The term “Employee” does not include those who do not receive any form of remuneration (volunteers), independent contractors or those engaged in certain casual domestic employment. Form I-9 has three sections. Employees complete Section 1. Employers complete Section 2 and, when applicable, Section 3. Employers may be fined if the form is not properly completed. See 8 USC § 1324a and 8 CFR § 274a.10. Individuals may be prosecuted for knowingly and willfully entering false information on the form. Employers are responsible for retaining completed forms. Do not mail completed forms to U.S. Citizenship and Immigration Services (USCIS) or Immigration and Customs Enforcement (ICE). These instructions will assist you in properly completing Form I-9. The employer must ensure that all pages of the instructions and Lists of Acceptable Documents are available, either in print or electronically, to all employees completing this form. When completing the form on a computer, the English version of the form includes specific instructions for each field and drop-down lists for universally used abbreviations and acceptable documents. To access these instructions, move the cursor over each field or click on the question mark symbol ( ) within the field. Employers and employees can also access this full set of instructions at any time by clicking the Instructions button at the top of each page when completing the form on a computer that is connected to the Internet. Employers and employees may choose to complete any or all sections of the form on paper or using a computer, or a combination of both. Forms I-9 obtained from the USCIS website are not considered electronic Forms I-9 under DHS regulations and, therefore, cannot be electronically signed. Therefore, regardless of the method you used to enter information into each field, you must print a hard copy of the form, then sign and date the hard copy by hand where required. Employers can obtain a blank copy of Form I-9 from the USCIS website at https://www.uscis.gov/i-9. This form is in portable document format (.pdf) that is fillable and savable. That means that you may download it, or simply print out a blank copy to enter information by hand. You may also request paper Forms I-9 from USCIS. Certain features of Form I-9 that allow for data entry on personal computers may make the form appear to be more than two pages. When using a computer, Form I-9 has been designed to print as two pages. Using more than one preparer and/or translator will add an additional page to the form, regardless of your method of completion. You are not required to print, retain or store the page containing the Lists of Acceptable Documents.

Form I-9 Instructions 10/21/2019 Page 1 of 15 The form will also populate certain fields with N/A when certain user choices ensure that particular fields will not be completed. The Print button located at the top of each page that will print any number of pages the user selects. Also, the Start Over button located at the top of each page will clear all the fields on the form. The Spanish version of Form I-9 does not include the additional instructions and drop-down lists described above. Employers in Puerto Rico may use either the Spanish or English version of the form. Employers outside of Puerto Rico must retain the English version of the form for their records, but may use the Spanish form as a translation tool. Additional guidance to complete the form may be found in the Handbook for Employers: Guidance for Completing Form I-9 (M-274) and on USCIS’ Form I-9 website, I-9 Central.

Completing Section I: Employee Information and Attestation

You, the employee, must complete each field in Section 1 as described below. Newly hired employees must complete and sign Section 1 no later than the first day of employment. Section 1 should never be completed before you have accepted a job offer. Entering Your Employee Information

Last Name (Family Name): Enter your full legal last name. Your last name is your family name or surname. If you have two last names or a hyphenated last name, include both names in the Last Name field. Examples of correctly entered last names include: De La Cruz, O’Neill, Garcia Lopez, Smith-Johnson, Nguyen. If you only have one name, enter it in this field, then enter “Unknown” in the First Name field. You may not enter “Unknown” in both the Last Name field and the First Name field.

First Name (Given Name): Enter your full legal first name. Your first name is your given name. Some examples of correctly entered first names include: Jessica, John-Paul, Tae Young, D’Shaun, Mai. If you only have one name, enter it in the Last Name field, then enter “Unknown” in this field. You may not enter “Unknown” in both the First Name field and the Last Name field. Middle Initial: Your middle initial is the first letter of your second given name, or the first letter of your middle name, if any. If you have more than one middle name, enter the first letter of your first middle name. If you do not have a middle name, enter N/A in this field. Other Last Names Used: Provide all other last names used, if any (e.g., maiden name). Enter N/A if you have not used other last names. For example, if you legally changed your last name from Smith to Jones, you should enter the name Smith in this field. Address (Street Name and Number): Enter the street name and number of the current address of your residence. If you are a border commuter from Canada or Mexico, you may enter your Canada or Mexico address in this field. If your residence does not have a physical address, enter a description of the location of your residence, such as “3 miles southwest of Anytown post office near water tower.” Apartment: Enter the number(s) or letter(s) that identify(ies) your apartment. If you do not live in an apartment, enter N/A. City or Town: Enter your city, town or village in this field. If your residence is not located in a city, town or village, enter your county, township, reservation, etc., in this field. If you are a border commuter from Canada, enter your city and province in this field. If you are a border commuter from Mexico, enter your city and state in this field. State: Enter the abbreviation of your state or territory in this field. If you are a border commuter from Canada or Mexico, enter your country abbreviation in this field. ZIP Code: Enter your 5-digit ZIP code. If you are a border commuter from Canada or Mexico, enter your 5- or 6-digit postal code in this field. Date of Birth (mm/dd/yyyy): Enter your date of birth as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). For example, enter January 8, 1980 as 01/08/1980. U.S. Social Security Number: Providing your 9-digit Social Security number is voluntary on Form I-9 unless your employer participates in E-Verify. If your employer participates in E-Verify and:

1. You have been issued a Social Security number, you must provide it in this field; or 2. You have applied for, but have not yet received a Social Security number, leave this field blank until you receive a Social Security number.

Form I-9 Instructions 10/21/2019 Page 2 of 15 Employee’s E-mail Address (Optional): Providing your e-mail address is optional on Form I-9, but the field cannot be left blank. To enter your e-mail address, use this format: [email protected]. One reason Department of Homeland Security (DHS) may e-mail you is if your employer uses E-Verify and DHS learns of a potential mismatch between the information provided and the information in government records. This e-mail would contain information on how to begin to resolve the potential mismatch. You may use either your personal or work e-mail address in this field. Enter N/A if you do not enter your e-mail address. Employee’s Telephone Number (Optional): Providing your telephone number is optional on Form I-9, but the field cannot be left blank. If you enter your area code and telephone number, use this format: 000-000-0000. Enter N/A if you do not enter your telephone number. Attesting to Your Citizenship or Immigration Status You must select one box to attest to your citizenship or immigration status. 1. A citizen of the United States. 2. A noncitizen national of the United States: An individual born in American Samoa, certain former citizens of the former Trust Territory of the Pacific Islands, and certain children of noncitizen nationals born abroad. 3. A lawful permanent resident: An individual who is not a U.S. citizen and who resides in the United States under legally recognized and lawfully recorded permanent residence as an immigrant. This term includes conditional residents. Asylees and refugees should not select this status, but should instead select "An Alien authorized to work" below. If you select “lawful permanent resident,” enter your 7- to 9-digit Alien Registration Number (A-Number), including the “A,” or USCIS Number in the space provided. When completing this field using a computer, use the dropdown provided to indicate whether you have entered an Alien Number or a USCIS Number. At this time, the USCIS Number is the same as the A-Number without the “A” prefix. 4. An alien authorized to work: An individual who is not a citizen or national of the United States, or a lawful permanent resident, but is authorized to work in the United States. If you select this box, enter the date that your employment authorization expires, if any, in the space provided. In most cases, your employment authorization expiration date is found on the document(s) evidencing your employment authorization. Refugees, asylees and certain citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, or Palau, and other aliens whose employment authorization does not have an expiration date should enter N/A in the Expiration Date field. In some cases, such as if you have Temporary Protected Status, your employment authorization may have been automatically extended; in these cases, you should enter the expiration date of the automatic extension in this space.

Aliens authorized to work must enter one of the following to complete Section 1: 1. Alien Registration Number (A-Number)/USCIS Number; or 2. Form I-94 Admission Number; or 3. Foreign Passport Number and the Country of Issuance. Your employer may not ask you to present the document from which you supplied this information. Alien Registration Number/USCIS Number: Enter your 7- to 9-digit Alien Registration Number (A-Number), including the “A,” or your USCIS Number in this field. At this time, the USCIS Number is the same as your A-Number without the “A” prefix. When completing this field using a computer, use the dropdown provided to indicate whether you have entered an Alien Number or a USCIS Number. If you do not provide an A-Number or USCIS Number, enter N/A in this field then enter either a Form I-94 Admission Number, or a Foreign Passport and Country of Issuance in the fields provided. Form I-94 Admission Number: Enter your 11-digit I-94 Admission Number in this field. If you do not provide an I-94 Admission Number, enter N/A in this field, then enter either an Alien Registration Number/USCIS Number or a Foreign Passport Number and Country of Issuance in the fields provided. Foreign Passport Number: Enter your Foreign Passport Number in this field. If you do not provide a Foreign Passport Number, enter N/A in this field, then enter either an Alien Number/USCIS Number or a I-94 Admission Number in the fields provided. Country of Issuance: If you entered your Foreign Passport Number, enter your Foreign Passport’s Country of Issuance. If you did not enter your Foreign Passport Number, enter N/A.

Form I-9 Instructions 10/21/2019 Page 3 of 15 Signature of Employee: After completing Section 1, sign your name in this field. If you used a form obtained from the USCIS website, you must print the form to sign your name in this field. By signing this form, you attest under penalty of perjury (28 U.S.C. § 1746) that the information you provided, along with the citizenship or immigration status you selected, and all information and documentation you provide to your employer, is complete, true and correct, and you are aware that you may face severe penalties provided by law and may be subject to criminal prosecution for knowingly and willfully making false statements or using false documentation when completing this form. Further, falsely attesting to U.S. citizenship may subject employees to penalties, removal proceedings and may adversely affect an employee's ability to seek future immigration benefits. If you cannot sign your name, you may place a mark in this field to indicate your signature. Employees who use a preparer or translator to help them complete the form must still sign or place a mark in the Signature of Employee field on the printed form. If you used a preparer, translator, and other individual to assist you in completing Form I-9: • Both you and your preparer(s) and/or translator(s) must complete the appropriate areas of Section 1, and then sign Section 1. If Section 1 was completed on a form obtained from the USCIS website, the form must be printed to sign these fields. You and your preparer(s) and/or translator(s) also should review the instructions for Completing the Preparer and/or Translator Certification below. • If the employee is a minor (individual under 18) who cannot present an identity document, the employee's parent or legal guardian can complete Section 1 for the employee and enter “minor under age 18” in the signature field. If Section 1 was completed on a form obtained from the USCIS website, the form must be printed to enter this information. The minor's parent or legal guardian should review the instructions for Completing the Preparer and/or Translator Certification below. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more guidance on completion of Form I-9 for minors. If the minor's employer participates in E-Verify, the employee must present a list B identity document with a photograph to complete Form I-9. • If the employee is a person with a disability (who is placed in employment by a nonprofit organization, association or as part of a rehabilitation program) who cannot present an identity document, the employee's parent, legal guardian or a representative of the nonprofit organization, association or rehabilitation program can complete Section 1 for the employee and enter “Special Placement” in this field. If Section 1 was completed on a form obtained from the USCIS website, the form must be printed to enter this information. The parent, legal guardian or representative of the nonprofit organization, association or rehabilitation program completing Section 1 for the employee should review the instructions for Completing the Preparer and/or Translator Certification below. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more guidance on completion of Form I-9 for certain employees with disabilities.

Today's Date: Enter the date you signed Section 1 in this field. Do not backdate this field. Enter the date as a 2-digit month, 2-digit day and 4-digit year (mm/dd/yyyy). For example, enter January 8, 2014 as 01/08/2014. A preparer or translator who assists the employee in completing Section 1 may enter the date the employee signed or made a mark to sign Section 1 in this field. Parents or legal guardians assisting minors (individuals under age 18) and parents, legal guardians or representatives of a nonprofit organization, association or rehabilitation program assisting certain employees with disabilities must enter the date they completed Section 1 for the employee.

Completing the Preparer and/or Translator Certification If you did not use a preparer or translator to assist you in completing Section 1, you, the employee, must check the box marked I did not use a Preparer or Translator. If you check this box, leave the rest of the fields in this area blank. If one or more preparers and/or translators assist the employee in completing the form using a computer, the preparer and/or translator must check the box marked “A preparer(s) and/or translator(s) assisted the employee in completing Section 1”, then select the number of Certification areas needed from the dropdown provided. Any additional Certification areas generated will result in an additional page. The Form I-9 Supplement, Section 1 Preparer and/or Translator Certification, can be separately downloaded from the USCIS Form I-9 webpage, which provides additional Certification areas for those completing Form I-9 using a computer who need more Certification areas than the 5 provided or those who are completing Form I-9 on paper. The first preparer and/or translator must complete all the fields in the Certification area on the same page the employee has signed. There is no limit to the number of preparers and/or translators an employee can use, but each additional preparer and/or translator must complete and sign a separate Certification area. Ensure the employee's last name, first name and middle initial are entered at the top of any additional pages. The employer must ensure that any additional pages are retained with the employee's completed Form I-9.

Form I-9 Instructions 10/21/2019 Page 4 of 15 Signature of Preparer or Translator: Any person who helped to prepare or translate Section 1of Form I-9 must sign his or her name in this field. If you used a form obtained from the USCIS website, you must print the form to sign your name in this field. The Preparer and/or Translator Certification must also be completed if “Individual under Age 18” or “Special Placement” is entered in lieu of the employee’s signature in Section 1. Today's Date: The person who signs the Preparer and/or Translator Certification must enter the date he or she signs in this field on the printed form. Do not backdate this field. Enter the date as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/ yyyy). For example, enter January 8, 2014 as 01/08/2014. Last Name (Family Name): Enter the full legal last name of the person who helped the employee in preparing or translating Section 1 in this field. The last name is also the family name or surname. If the preparer or translator has two last names or a hyphenated last name, include both names in this field. First Name (Given Name): Enter the full legal first name of the person who helped the employee in preparing or translating Section 1 in this field. The first name is also the given name. Address (Street Name and Number): Enter the street name and number of the current address of the residence of the person who helped the employee in preparing or translating Section 1 in this field. Addresses for residences in Canada or Mexico may be entered in this field. If the residence does not have a physical address, enter a description of the location of the residence, such as “3 miles southwest of Anytown post office near water tower.” If the residence is an apartment, enter the apartment number in this field. City or Town: Enter the city, town or village of the residence of the person who helped the employee in preparing or translating Section 1 in this field. If the residence is not located in a city, town or village, enter the name of the county, township, reservation, etc., in this field. If the residence is in Canada, enter the city and province in this field. If the residence is in Mexico, enter the city and state in this field. State: Enter the abbreviation of the state, territory or country of the preparer or translator’s residence in this field. ZIP Code: Enter the 5-digit ZIP code of the residence of the person who helped the employee in preparing or translating Section 1 in this field. If the preparer or translator's residence is in Canada or Mexico, enter the 5- or 6-digit postal code.

Presenting Form I-9 Documents

Within 3 business days of starting work for pay, you must present to your employer documentation that establishes your identity and employment authorization. For example, if you begin employment on Monday, you must present documentation on or before Thursday of that week. However, if you were hired to work for less than 3 business days, you must present documentation no later than the first day of employment. Choose which unexpired document(s) to present to your employer from the Lists of Acceptable Documents. An employer cannot specify which document(s) you may present from the Lists of Acceptable Documents. You may present either one selection from List A or a combination of one selection from List B and one selection from List C. Some List A documents, which show both identity and employment authorization, are combination documents that must be presented together to be considered a List A document: for example, the foreign passport together with a Form I-94 containing an endorsement of the alien’s nonimmigrant status and employment authorization with a specific employer incident to such status. List B documents show identity only and List C documents show employment authorization only. If your employer participates in E-Verify and you present a List B document, the document must contain a photograph. If you present acceptable List A documentation, you should not be asked to present, nor should you provide, List B and List C documentation. If you present acceptable List B and List C documentation, you should not be asked to present, nor should you provide, List A documentation. If you are unable to present a document(s) from these lists, you may be able to present an acceptable receipt. Refer to the Receipts section below. Your employer must review the document(s) you present to complete Form I-9. If your document(s) reasonably appears to be genuine and to relate to you, your employer must accept the documents. If your document(s) does not reasonably appear to be genuine or to relate to you, your employer must reject it and provide you with an opportunity to present other documents from the Lists of Acceptable Documents. Your employer may choose to make copies of your document(s), but must return the original(s) to you. Your employer must review your documents in your physical presence.

Form I-9 Instructions 10/21/2019 Page 5 of 15 Your employer will complete the other parts of this form, as well as review your entries in Section 1. Your employer may ask you to correct any errors found. Your employer is responsible for ensuring all parts of Form I-9 are properly completed and is subject to penalties under federal law if the form is not completed correctly. Minors (individuals under age 18) and certain employees with disabilities whose parent, legal guardian or representative completed Section 1 for the employee are only required to present an employment authorization document from List C. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more guidance on minors and certain individuals with disabilities. Receipts If you do not have unexpired documentation from the Lists of Acceptable Documents, you may be able to present a receipt(s) in lieu of an acceptable document(s). New employees who choose to present a receipt(s) must do so within three business days of their first day of employment. If your employer is reverifying your employment authorization, and you choose to present a receipt for reverification, you must present the receipt by the date your employment authorization expires. Receipts are not acceptable if employment lasts fewer than three business days. There are three types of acceptable receipts: 1. A receipt showing that you have applied to replace a document that was lost, stolen or damaged. You must present the actual document within 90 days from the date of hire or, in the case of reverification, within 90 days from the date your original employment authorization expires. 2. The arrival portion of Form I-94/I-94A containing a temporary I-551 stamp and a photograph of the individual. You must present the actual Permanent Resident Card (Form I-551) by the expiration date of the temporary I-551 stamp, or, if there is no expiration date, within 1 year from the date of admission. 3. The departure portion of Form I-94/I-94A with a refugee admission stamp. You must present an unexpired Employment Authorization Document (Form I-766) or a combination of a List B document and an unrestricted Social Security Card within 90 days from the date of hire or, in the case of reverification, within 90 days from the date your original employment authorization expires.

Receipts showing that you have applied for an initial grant of employment authorization, or for renewal of your expiring or expired employment authorization, are not acceptable.

Completing Section 2: Employer or Authorized Representative Review and Verification

You, the employer, must ensure that all parts of Form I-9 are properly completed and may be subject to penalties under federal law if the form is not completed correctly. Section 1 must be completed no later than the employee’s first day of employment. You may not ask an individual to complete Section 1 before he or she has accepted a job offer. Before completing Section 2, you should review Section 1 to ensure the employee completed it properly. If you find any errors in Section 1, have the employee make corrections, as necessary and initial and date any corrections made. You may designate an authorized representative to act on your behalf to complete Section 2. An authorized representative can be any person you designate to complete and sign Form I-9 on your behalf. You are liable for any violations in connection with the form or the verification process, including any violations of the employer sanctions laws committed by the person designated to act on your behalf. You or your authorized representative must complete Section 2 by examining evidence of identity and employment authorization within 3 business days of the employee’s first day of employment. For example, if an employee begins employment on Monday, you must review the employee's documentation and complete Section 2 on or before Thursday of that week. However, if you hire an individual for less than 3 business days, Section 2 must be completed no later than the first day of employment.

Entering Employee Information from Section 1 This area, titled, “Employee Info from Section 1” contains fields to enter the employee's last name, first name, middle initial exactly as he or she entered them in Section 1. This area also includes a Citizenship/Immigration Status field to enter the number of the citizenship or immigration status checkbox the employee selected in Section 1. These fields help to ensure that the two pages of an employee's Form I-9 remain together. When completing Section 2 using a computer, the number entered in the Citizenship/Immigration Status field provides drop-downs that directly relate to the employee's selected citizenship or immigration status.

Form I-9 Instructions 10/21/2019 Page 6 of 15 Entering Documents the Employee Presents You, the employer or authorized representative, must physically examine, in the employee's physical presence, the unexpired document(s) the employee presents from the Lists of Acceptable Documents to complete the Document fields in Section 2. You cannot specify which document(s) an employee may present from these lists. If you discriminate in the Form I-9 process based on an individual's citizenship status, immigration status, or national origin, you may be in violation of the law and subject to sanctions such as civil penalties and be required to pay back pay to discrimination victims. A document is acceptable as long as it reasonably appears to be genuine and to relate to the person presenting it. Employees must present one selection from List A or a combination of one selection from List B and one selection from List C. List A documents show both identity and employment authorization. Some List A documents are combination documents that must be presented together to be considered a List A document, such as a foreign passport together with a Form I-94 containing an endorsement of the alien’s nonimmigrant status. List B documents show identity only, and List C documents show employment authorization only. If an employee presents a List A document, do not ask or require the employee to present List B and List C documents, and vice versa. If an employer participates in E-Verify and the employee presents a List B document, the List B document must include a photograph. If an employee presents a receipt for the application to replace a lost, stolen or damaged document, the employee must present the replacement document to you within 90 days of the first day of work for pay, or in the case of reverification, within 90 days of the date the employee's employment authorization expired. Enter the word “Receipt” followed by the title of the receipt in Section 2 under the list that relates to the receipt. When your employee presents the replacement document, draw a line through the receipt, then enter the information from the new document into Section 2. Other receipts may be valid for longer or shorter periods, such as the arrival portion of Form I-94/ I-94A containing a temporary I-551 stamp and a photograph of the individual, which is valid until the expiration date of the temporary I-551 stamp or, if there is no expiration date, valid for one year from the date of admission. Ensure that each document is an unexpired, original (no photocopies, except for certified copies of birth certificates) document. Certain employees may present an expired employment authorization document, which may be considered unexpired, if the employee's employment authorization has been extended by regulation or a Federal Register Notice. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) or I-9 Central for more guidance on these special situations. Refer to the M-274 for guidance on how to handle special situations, such as students (who may present additional documents not specified on the Lists) and H-1B and H-2A nonimmigrants changing employers. Minors (individuals under age 18) and certain employees with disabilities whose parent, legal guardian or representative completed Section 1 for the employee are only required to present an employment authorization document from List C. Refer to the M-274 for more guidance on minors and certain persons with disabilities. If the minor's employer participates in E-Verify, the minor employee also must present a List B identity document with a photograph to complete Form I-9. You must return original document(s) to the employee, but may make photocopies of the document(s) reviewed. Photocopying documents is voluntary unless you participate in E-Verify. E-Verify employers are only required to photocopy certain documents. If you are an E-Verify employer who chooses to photocopy documents other than those you are required to photocopy, you should apply this policy consistently with respect to Form I-9 completion for all employees. For more information on the types of documents that an employer must photocopy if the employer uses E-Verify, visit E-Verify’s website at www.everify.gov. For non-E-Verify employers, if photocopies are made, they should be made consistently for ALL new hires and reverified employees. Photocopies must be retained and presented with Form I-9 in case of an inspection by DHS or another federal government agency. You must always complete Section 2 by reviewing original documentation, even if you photocopy an employee’s document(s) after reviewing the documentation. Making photocopies of an employee’s document(s) cannot take the place of completing Form I-9. You are still responsible for completing and retaining Form I-9.

Form I-9 Instructions 10/21/2019 Page 7 of 15 List A - Identity and Employment Authorization: If the employee presented an acceptable document(s) from List A or an acceptable receipt for a List A document, enter the document(s) information in this column. If the employee presented a List A document that consists of a combination of documents, enter information from each document in that combination in a separate area under List A as described below. All documents must be unexpired. If you enter document information in the List A column, you should not enter document information or N/A in the List B or List C columns. If you complete Section 2 using a computer, a selection in List A will fill all the fields in the Lists B and C columns with N/A.

Document Title: If the employee presented a document from List A, enter the title of the List A document or receipt in this field. The abbreviations provided are available in the dropdown when the form is completed on a computer. When completing the form on paper, you may choose to use these abbreviations or any other common abbreviation to enter the document title or issuing authority. If the employee presented a combination of documents, use the second and third Document Title fields as necessary.

Full name of List A Document Abbreviations U.S. Passport U.S. Passport U.S. Passport Card U.S. Passport Card Permanent Resident Card (Form I-551) Perm. Resident Card (Form I-551) Alien Registration Receipt Card (Form I-551) Alien Reg. Receipt Card (Form I-551) 1. Foreign Passport Foreign passport containing a temporary I-551 stamp 2. Temporary I-551 Stamp Foreign passport containing a temporary I-551 printed notation on a 1. Foreign Passport machine-readable immigrant visa (MRIV) 2. Machine-readable immigrant visa (MRIV) Employment Authorization Document (Form I-766) Employment Auth. Document (Form I-766) For a nonimmigrant alien authorized to work for a specific employer 1. Foreign Passport, work-authorized non-immigrant because of his or her status, a foreign passport 2. Form I-94/I94A with Form I/94/I-94A that contains an endorsement of the alien's 3. Form I-20 or Form DS-2019 nonimmigrant status Note: In limited circumstances, certain J-1 students may be required to present a letter from their Responsible Officer in order to work. Enter the document title, issuing authority, document number and expiration date from this document in the Additional Information field.

Passport from the Federated States of Micronesia (FSM) 1. FSM Passport with Form I-94 with Form I-94/I-94A 2. Form I-94/I94A Passport from the Republic of the Marshall Islands (RMI) 1. RMI Passport with Form I-94 with Form I-94/I94A 2. Form I-94/I94A Receipt: The arrival portion of Form I-94/I-94A containing a temporary Receipt: Form I-94/I-94A w/I-551 stamp, photo I-551 stamp and photograph Receipt: The departure portion of Form I-94/I-94A Receipt: Form I-94/I-94A w/refugee stamp with an unexpired refugee admission stamp Receipt for an application to replace a lost, stolen or damaged Receipt replacement Perm. Res. Card Permanent Resident Card (Form I-551) (Form I-551) Receipt for an application to replace a lost, stolen or damaged Receipt replacement EAD (Form I-766) Employment Authorization Document (Form I-766) Receipt for an application to replace a lost, stolen or damaged foreign 1. Receipt: Replacement Foreign Passport, passport with Form I-94/I-94A that contains an endorsement of the work-authorized nonimmigrant alien's nonimmigrant status 2. Receipt: Replacement Form I-94/I-94A 3. Form I-20 or Form DS-2019 (if presented) Receipt for an application to replace a lost, stolen or damaged 1. Receipt: Replacement FSM Passport with Form I-94 passport from the Federated States of Micronesia with Form I-94/I-94A 2. Receipt: Replacement Form I-94/I-94A Receipt for an application to replace a lost, stolen or damaged 1. Receipt: Replacement RMI Passport with Form I-94 passport from the Republic of the Marshall Islands with Form I-94/ 2. Receipt: Replacement Form I-94/I-94A I-94A

Issuing Authority: Enter the issuing authority of the List A document or receipt. The issuing authority is the specific entity that issued the document. If the employee presented a combination of documents, use the second and third Issuing Authority fields as necessary.

Form I-9 Instructions 10/21/2019 Page 8 of 15 Document Number: Enter the document number, if any, of the List A document or receipt presented. If the document does not contain a number, enter N/A in this field. If the employee presented a combination of documents, use the second and third Document Number fields as necessary. If the document presented was a Form I-20 or DS-2019, enter the Student and Exchange Visitor Information System (SEVIS) number in the third Document Number field exactly as it appears on the Form I-20 or the DS-2019. Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the List A document. The document is not acceptable if it has already expired. If the document does not contain an expiration date, enter N/A in this field. If the document uses text rather than a date to indicate when it expires, enter the text as shown on the document, such as “D/S” (which means, “duration of status”). For a receipt, enter the expiration date of the receipt validity period as described above. If the employee presented a combination of documents, use the second and third Expiration Date fields as necessary. If the document presented was a Form I-20 or DS-2019, enter the program end date here.

List B - Identity: If the employee presented an acceptable document from List B or an acceptable receipt for the application to replace a lost, stolen, or destroyed List B document, enter the document information in this column. If a parent or legal guardian attested to the identity of an employee who is an individual under age 18 or certain employees with disabilities in Section 1, enter either "Individual under age 18" or "Special Placement" in this field. Refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) for more guidance on individuals under age 18 and certain person with disabilities. If you enter document information in the List B column, you must also enter document information in the List C column. If an employee presents acceptable List B and List C documents, do not ask the employees to present a List A document. If you enter document information in List B, you should not enter document information or N/A in List A. If you complete Section 2 using a computer, a selection in List B will fill all the fields in the List A column with N/A. Document Title: If the employee presented a document from List B, enter the title of the List B document or receipt in this field. The abbreviations provided are available in the dropdown when the form is completed on a computer. When completing the form on paper, you may choose to use these abbreviations or any other common abbreviations to document the document title or issuing authority.

Full name of List B Document Abbreviations Driver's license issued by a State or outlying possession of the United Driver's license issued by state/territory States ID card issued by a State or outlying possession of the ID card issued by state/territory United States

ID card issued by federal, state, or local government agencies or

entities (Note: This selection does not include the driver's license or ID Government ID card issued by a State or outlying possession of the United States as described in B1 of the List of Acceptable Documents.)

School ID card with photograph School ID Voter's registration card Voter registration card U.S. Military card U.S. Military card U.S. Military draft record U.S. Military draft record Military dependent's ID card Military dependent's ID card U.S. Coast Guard Merchant Mariner Card USCG Merchant Mariner card Native American tribal document Native American tribal document Driver's license issued by a Canadian government authority Canadian driver's license School record (for persons under age 18 who are unable to present a School record (under age 18) document listed above) Report card (for persons under age 18 who are unable to present a Report card (under age 18) document listed above) Clinic record (for persons under age 18 who are unable to present a Clinic record (under age 18) document listed above) Doctor record (for persons under age 18 who are unable to present a Doctor record (under age 18) document listed above) Hospital record (for persons under age 18 who are unable to present a Hospital record (under age 18) document listed above) Day-care record (for persons under age 18 who are unable to present Day-care record (under age 18) a document listed above) Nursery school record (for persons under age 18 who are unable to Nursery school record (under age 18) present a document listed above)

Form I-9 Instructions 10/21/2019 Page 9 of 15

Full name of List B Document Abbreviations Individual under age 18 endorsement by parent or guardian Individual under Age 18 Special placement endorsement for persons with disabilities Special Placement

Receipt for the application to replace a lost, stolen or damaged Driver's Receipt: Replacement driver's license License issued by a State or outlying possession of the United States

Receipt for the application to replace a lost, stolen or damaged ID card Receipt: Replacement ID card issued by a State or outlying possession of the United States

Receipt for the application to replace a lost, stolen or damaged ID card Receipt: Replacement Gov't ID issued by federal, state, or local government agencies or entities

Receipt for the application to replace a lost, stolen or damaged School Receipt: Replacement School ID ID card with photograph Receipt for the application to replace a lost, stolen or damaged Voter's Receipt: Replacement Voter reg. card registration card Receipt for the application to replace a lost, stolen or damaged U.S. Receipt: Replacement U.S. Military card Military card Receipt for the application to replace a lost, stolen or damaged Military Receipt: Replacement U.S. Military dep. card dependent's ID card Receipt for the application to replace a lost, stolen or damaged U.S. Receipt: Replacement Military draft Military draft record record Receipt for the application to replace a lost, stolen or damaged U.S. Receipt: Replacement Merchant Mariner card Coast Guard Merchant Mariner Card

Receipt for the application to replace a lost, stolen or damaged Driver's Receipt: Replacement Canadian DL license issued by a Canadian government authority

Receipt for the application to replace a lost, stolen or damaged Native Receipt: Replacement Native American American tribal document tribal doc Receipt for the application to replace a lost, stolen or damaged School Receipt: Replacement School record record (for persons under age 18 who are unable to present a (under age 18) document listed above) Receipt for the application to replace a lost, stolen or damaged Report Receipt: Replacement Report card card (for persons under age 18 who are unable to present a document (under age 18) listed above) Receipt for the application to replace a lost, stolen or damaged Clinic Receipt: Replacement Clinic record record (for persons under age 18 who are unable to present a (under age 18) document listed above) Receipt for the application to replace a lost, stolen or damaged Doctor Receipt: Replacement Doctor record record (for persons under age 18 who are unable to present a (under age 18) document listed above) Receipt for the application to replace a lost, stolen or damaged Receipt: Replacement Hospital record Hospital record (for persons under age 18 who are unable to present a (under age 18) document listed above) Receipt for the application to replace a lost, stolen or damaged Day- Receipt: Replacement Day-care record care record (for persons under age 18 who (under age 18) are unable to present a document listed above) Receipt for the application to replace a lost, stolen or damaged Receipt: Replacement Nursery school record (under Nursery school record (for persons under age 18 who are unable to age 18) present a document listed above) Issuing Authority: Enter the issuing authority of the List B document or receipt. The issuing authority is the entity that issued the document. If the employee presented a document that is issued by a state agency, include the state as part of the issuing authority. Document Number: Enter the document number, if any, of the List B document or receipt exactly as it appears on the document. If the document does not contain a number, enter N/A in this field. Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the List B document. The document is not acceptable if it has already expired. If the document does not contain an expiration date, enter N/A in this field. For a receipt, enter the expiration date of the receipt validity period as described in the Receipt section above.

Form I-9 Instructions 10/21/2019 Page 10 of 15 List C - Employment Authorization: If the employee presented an acceptable document from List C, or an acceptable receipt for the application to replace a lost, stolen, or destroyed List C document, enter the document information in this column. If you enter document information in the List C column, you must also enter document information in the List B column. If an employee presents acceptable List B and List C documents, do not ask the employee to present a list A document. If you enter document information in List C, you should not enter document information or N/A in List A. If you complete Section 2 using a computer, a selection in List C will fill all the fields in the List A column with N/A. Document Title: If the employee presented a document from List C, enter the title of the List C document or receipt in this field. The abbreviations provided are available in the dropdown when the form is completed on a computer. When completing the form on paper, you may choose to use these abbreviations or any other common abbreviations to document the document title or issuing authority. If you are completing the form on a computer, and you select an Employment authorization document issued by DHS, the field will populate with List C #7 and provide a space for you to enter a description of the documentation the employee presented. Refer to the M-274 for guidance on entering List C #7 documentation.

Full name of List C Document Abbreviations Social Security Account Number card without restrictions (Unrestricted) Social Security Card Certification of Birth Abroad (Form FS-545) Form FS-545 Certification of Report of Birth (Form DS-1350) Form DS-1350 Consular Report of Birth Abroad (Form FS-240) Form FS-240 Original or certified copy of a U.S. birth certificate bearing an official seal Birth Certificate Native American tribal document Native American tribal document U.S. Citizen ID Card (Form I-197) Form I-197 Identification Card for use of Resident Citizen in the United States (Form Form I-179 I-179) Employment authorization document issued by DHS (List C #7) (Note: This selection does not include the Employment Authorization Document (Form Employment Auth. document (DHS) List C #7 I-766) from List A.) Receipt for the application to replace a lost, stolen or damaged Social Receipt: Replacement Unrestricted SS Card Security Account Number Card without restrictions Receipt for the application to replace a lost, stolen or damaged Original or Receipt: Replacement Birth Certificate certified copy of a U.S. birth certificate bearing an official seal Receipt for the application to replace a lost, stolen or damaged Native Receipt: Replacement Native American Tribal Doc. American Tribal Document Receipt for the application to replace a lost, stolen or damaged Employment Receipt: Replacement Employment Auth. Doc. (DHS) Authorization Document issued by DHS Issuing Authority: Enter the issuing authority of the List C document or receipt. The issuing authority is the entity that issued the document. Document Number: Enter the document number, if any, of the List C document or receipt exactly as it appears on the document. If the document does not contain a number, enter N/A in this field. Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the List C document. The document is not acceptable if it has already expired, unless USCIS has extended the expiration date on the document. For instance, if a conditional resident presents a Form I-797 extending his or her conditional resident status with the employee's expired Form I-551, enter the future expiration date as indicated on the Form I-797. If the document has no expiration date, enter N/A in this field. For a receipt, enter the expiration date of the receipt validity period as described in the Receipt section above. Additional Information: Use this space to notate any additional information required for Form I-9 such as: • Employment authorization extensions for Temporary Protected Status beneficiaries, F-1 OPT STEM students, CAP- GAP, H-1B and H-2A employees continuing employment with the same employer or changing employers, and other nonimmigrant categories that may receive extensions of stay • Additional document(s) that certain nonimmigrant employees may present • Discrepancies that E-Verify employers must notate when participating in the IMAGE program • Employee termination dates and form retention dates • E-Verify case number, which may also be entered in the margin or attached as a separate sheet per E-Verify requirements and your chosen business process • Any other comments or notations necessary for the employer's business process You may leave this field blank if the employee's circumstances do not require additional notations.

Form I-9 Instructions 10/21/2019 Page 11 of 15 Entering Information in the Employer Certification Employee's First Day of Employment: Enter the employee's first day of employment as a 2-digit month, 2-digit day and 4-digit year (mm/dd/yyyy). Signature of Employer or Authorized Representative: Review the form for accuracy and completeness. The person who physically examines the employee's original document(s) and completes Section 2 must sign his or her name in this field. If you used a form obtained from the USCIS website, you must print the form to sign your name in this field. By signing Section 2, you attest under penalty of perjury (28 U.S.C. § 1746) that you have physically examined the documents presented by the employee, the document(s) reasonably appear to be genuine and to relate to the employee named, that to the best of your knowledge the employee is authorized to work in the United States, that the information you entered in Section 2 is complete, true and correct to the best of your knowledge, and that you are aware that you may face severe penalties provided by law and may be subject to criminal prosecution for knowingly and willfully making false statements or knowingly accepting false documentation when completing this form. Today's Date: The person who signs Section 2 must enter the date he or she signed Section 2 in this field. Do not backdate this field. If you used a form obtained from the USCIS website, you must print the form to write the date in this field. Enter the date as a 2-digit month, 2-digit day and 4-digit year (mm/dd/yyyy). For example, enter January 8, 2014 as 01/08/2014. Title of Employer or Authorized Representative: Enter the title, position or role of the person who physically examines the employee's original document(s), completes and signs Section 2. Last Name of the Employer or Authorized Representative: Enter the full legal last name of the person who physically examines the employee’s original documents, completes and signs Section 2. Last name refers to family name or surname. If the person has two last names or a hyphenated last name, include both names in this field. First Name of the Employer or Authorized Representative: Enter the full legal first name of the person who physically examines the employee’s original documents, completes, and signs Section 2. First name refers to the given name. Employer’s Business or Organization Name: Enter the name of the employer’s business or organization in this field. Employer’s Business or Organization Address (Street Name and Number): Enter an actual, physical address of the employer. If your company has multiple locations, use the most appropriate address that identifies the location of the employer. Do not provide a P.O. Box address. City or Town: Enter the city or town for the employer’s business or organization address. If the location is not a city or town, you may enter the name of the village, county, township, reservation, etc, that applies. State: Enter the two-character abbreviation of the state for the employer’s business or organization address. ZIP Code: Enter the 5-digit ZIP code for the employer’s business or organization address.

Completing Section 3: Reverification and Rehires

Section 3 applies to both reverification and rehires. When completing this section, you must also complete the Last Name, First Name and Middle Initial fields in the Employee Info from Section 1 area at the top of Section 2, leaving the Citizenship/ Immigration Status field blank. When completing Section 3 in either a reverification or rehire situation, if the employee’s name has changed, record the new name in Block A. Reverification Reverification in Section 3 must be completed prior to the earlier of: • The expiration date, if any, of the employment authorization stated in Section 1, or • The expiration date, if any, of the List A or List C employment authorization document recorded in Section 2 (with some exceptions listed below). Some employees may have entered “N/A” in the expiration date field in Section 1 if they are aliens whose employment authorization does not expire, e.g. asylees, refugees, certain citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, or Palau. Reverification does not apply for such employees unless they choose to present evidence of employment authorization in Section 2 that contains an expiration date and requires reverification, such as Form I-766, Employment Authorization Document. You should not reverify U.S. citizens and noncitizen nationals, or lawful permanent residents (including conditional residents) who presented a Permanent Resident Card (Form I-551). Reverification does not apply to List B documents.

Form I-9 Instructions 10/21/2019 Page 12 of 15 For reverification, an employee must present an unexpired document(s) (or a receipt) from either List A or List C showing he or she is still authorized to work. You CANNOT require the employee to present a particular document from List A or List C. The employee is also not required to show the same type of document that he or she presented previously. See specific instructions on how to complete Section 3 below. Rehires If you rehire an employee within three years from the date that the Form I-9 was previously executed, you may either rely on the employee’s previously executed Form I-9 or complete a new Form I-9. If you choose to rely on a previously completed Form I-9, follow these guidelines. • If the employee remains employment authorized as indicated on the previously executed Form I-9, the employee does not need to provide any additional documentation. Provide in Section 3 the employee’s rehire date, any name changes if applicable, and sign and date the form. • If the previously executed Form I-9 indicates that the employee’s employment authorization from Section 1 or employment authorization documentation from Section 2 that is subject to reverification has expired, then reverification of employment authorization is required in Section 3 in addition to providing the rehire date. If the previously executed Form I-9 is not the current version of the form, you must complete Section 3 on the current version of the form. • If you already used Section 3 of the employee’s previously executed Form I-9, but are rehiring the employee within three years of the original execution of Form I-9, you may complete Section 3 on a new Form I-9 and attach it to the previously executed form.

Employees rehired after three years of original execution of the Form I-9 must complete a new Form I-9. Complete each block in Section 3 as follows: Block A - New Name: If an employee who is being reverified or rehired has also changed his or her name since originally completing Section 1 of this form, complete this block with the employee’s new name. Enter only the part of the name that has changed, for example: if the employee changed only his or her last name, enter the last name in the Last Name field in this Block, then enter N/A in the First Name and Middle Initial fields. If the employee has not changed his or her name, enter N/A in each field of Block A. Block B - Date of Rehire: Complete this block if you are rehiring an employee within three years of the date Form I-9 was originally executed. Enter the date of rehire in this field. Enter N/A in this field if the employee is not being rehired. Block C - Complete this block if you are reverifying expiring or expired employment authorization or employment authorization documentation of a current or rehired employee. Enter the information from the List A or List C document(s) (or receipt) that the employee presented to reverify his or her employment authorization. All documents must be unexpired. Document Title: Enter the title of the List A or C document (or receipt) the employee has presented to show continuing employment authorization in this field. Document Number: Enter the document number, if any, of the document you entered in the Document Title field exactly as it appears on the document. Enter N/A if the document does not have a number. Expiration Date (if any) (mm/dd/yyyy): Enter the expiration date, if any, of the document you entered in the Document Title field as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). If the document does not contain an expiration date, enter N/A in this field. Signature of Employer or Authorized Representative: The person who completes Section 3 must sign in this field. If you used a form obtained from the USCIS website, you must print Section 3 of the form to sign your name in this field. By signing Section 3, you attest under penalty of perjury (28 U.S.C. §1746) that you have examined the documents presented by the employee, that the document(s) reasonably appear to be genuine and to relate to the employee named, that to the best of your knowledge the employee is authorized to work in the United States, that the information you entered in Section 3 is complete, true and correct to the best of your knowledge, and that you are aware that you may face severe penalties provided by law and may be subject to criminal prosecution for knowingly and willfully making false statements or knowingly accepting false documentation when completing this form.

Form I-9 Instructions 10/21/2019 Page 13 of 15 Today's Date: The person who completes Section 3 must enter the date Section 3 was completed and signed in this field. Do not backdate this field. If you used a form obtained from the USCIS website, you must print Section 3 of the form to enter the date in this field. Enter the date as a 2-digit month, 2-digit day, and 4-digit year (mm/dd/yyyy). For example, enter January 8, 2014 as 01/08/2014. Name of Employer or Authorized Representative: The person who completed, signed and dated Section 3 must enter his or her name in this field.

What is the Filing Fee?

There is no fee for completing Form I-9. This form is not filed with USCIS or any government agency. Form I-9 must be retained by the employer and made available for inspection by U.S. Government officials as specified in the “DHS Privacy Notice” below.

USCIS Forms and Information

For additional guidance about Form I-9, employers and employees should refer to the Handbook for Employers: Guidance for Completing Form I-9 (M-274) or USCIS’ Form I-9 website at https://www.uscis.gov/i-9-central. You can also obtain information about Form I-9 by e-mailing USCIS at [email protected], or by calling 1-888-464-4218 or 1-877-875-6028 (TTY). You may download and obtain the English and Spanish versions of Form I-9, the Handbook for Employers, or the instructions to Form I-9 from the USCIS website at https://www.uscis.gov/i-9. To complete Form I-9 on a computer, you will need the latest version of Adobe Reader, which can be downloaded for free at http://get.adobe.com/reader/. You may order paper forms at https://www.uscis.gov/forms/forms-by-mail or by contacting the USCIS Contact Center at 1-800-375-5283 or 1-800-767-1833 (TTY). Information about E-Verify, a web-based system that allows employers to confirm the eligibility of their employees to work in the United States, can be obtained at https://www.e-verify.gov or by contacting E-Verify at https://www.e-verify.gov/contact-us. Employees with questions about Form I-9 and/or E-Verify can reach the USCIS employee hotline by calling 1-888-897-7781 or 1-877-875-6028 (TTY).

Photocopying Blank and Completed Forms I-9 and Retaining Completed Forms I-9

Employers may photocopy or print blank Forms I-9 for future use. All pages of the instructions and Lists of Acceptable Documents must be available, either in print or electronically, to all employees completing this form. Employers must retain each employee's completed Form I-9 for as long as the individual works for the employer and for a specified period after employment has ended. Employers are required to retain the pages of the form on which the employee and employer entered data. If copies of documentation presented by the employee are made, those copies must also be retained. Once the individual's employment ends, the employer must retain this form and attachments for either 3 years after the date of hire (i.e., first day of work for pay) or 1 year after the date employment ended, whichever is later. In the case of recruiters or referrers for a fee (only applicable to those that are agricultural associations, agricultural employers, or farm labor contractors), the retention period is 3 years after the date of hire (i.e., first day of work for pay). Forms I-9 obtained from the USCIS website that are not printed and signed manually (by hand) are not considered complete. In the event of an inspection, retaining incomplete forms may make you subject to fines and penalties associated with incomplete forms. Employers should ensure that information employees provide on Form I-9 is used only for Form I-9 purposes. Completed Forms I-9 and all accompanying documents should be stored in a safe, secure location. Form I-9 may be generated, signed, and retained electronically, in compliance with Department of Homeland Security regulations at 8 CFR 274a.2.

Form I-9 Instructions 10/21/2019 Page 14 of 15

DHS Privacy Notice

AUTHORITIES: The information requested on this form, and the associated documents, are collected under the Immigration Reform and Control Act of 1986, Pub. L. 99-603 (8 USC 1324a). PURPOSE: The primary purpose for providing the requested information on this form is for employers to verify your identity and employment authorization. Consistent with the requirements of the Immigration Reform and Control Act of 1986, employers use the Form I-9 to document the verification of the identity and employment authorization for new employees to prevent the unlawful hiring, or recruiting or referring for a fee, of aliens who are not authorized to work in the United States. This form is completed by both the employer and employee, and is ultimately retained by the employer. DISCLOSURE: The information you provide is voluntary. However, failure to provide the requested information, including your Social Security number (if applicable), and any requested evidence, may result in termination of employment. Failure of the employer to ensure proper completion of this form may result in the imposition of civil or criminal penalties against the employer. In addition, knowingly employing individuals who are not authorized to work in the United States may subject the employer to civil and/or criminal penalties. ROUTINE USES: This information will be used by employers as a record of their basis for determining eligibility of an individual to work in the United States. The employer must retain this completed form and make it available for inspection by authorized officials of the Department of Homeland Security, Department of Labor, and Department of Justice, Civil Rights Division, Immigrant and Employee Rights Section. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest of national security.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is estimated at 35 minutes per response, when completing the form manually, and 26 minutes per response when using a computer to aid in completion of the form, including the time for reviewing instructions and completing and retaining the form. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20 Massachusetts Avenue NW, Washington, DC 20529-2140; OMB No. 1615-0047. Do not mail your completed Form I-9 to this address.

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