Annual Badge Renewal

2. First Name*
3. Last Name*
5. Phone Number*
6. Email Address*
8. Employer*
   -- Select One --MPDMFDTrinity HealthCity of Minot

   Please select your employer from the drop down

12. Identification Requirements

    In order to start the badging process two forms of identification are required. One must be a photo ID and the second is a document that authorizes employment. This is based off of I9 standards. You must select a form of ID from each box that you will bring the day of your appointment. Applications will not be accepted without acceptable forms of identification.<P>If born in the United States, please select one item from Photo ID list and one from Document to Establish Employment list. If born outside of the United States please select one item from the Photo ID list and one from the Documents for applicants born outside of US. 

    Please see the document below for I9 information. 

14. Document to Establish Identity *

    1. Driver's License
    2. Passport
    3. ID Card issued by federal, state, or local government
    4. Military ID
    5. Tribal Document
    6. Other
    7. PIV Card (TSA Only)
15. Documents to Establish Employment*

    1. Social Security Card
    2. Birth Certificate
    3. Forms DS1350, FS-545, FS-240, or I-179
    4. U.S. Citizen ID Card (Form I-797)
    5. Employment Authorization Document issued by DHS
    6. Other (as provided on I-9)
    7. Passport (only if not used for the first form)
17. Document for Citizen's born outside of the U.S.*

    1. Permanent Resident Card or Alien Registration receipt Card (From I-551)
    2. Foreign Passport*
    3. Form I-94 or From I-94A*
    4. Passport from FSM or RMI with Form I-94 or Form I-94A
    5. Form DS-1350
    6. Passport
    7. N/A Born in the United States

    *Please refer to I-9 document for questions 

19. 

23. Once you hit the submit button you will be directed to our scheduling website to make your appointment

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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