Employment Authorization Form
Employee Details
Robert E Theis
08/25/1952
Full Name: ___________________________________
Date of Birth: _________________
475-56-4427
Consultant
Social Security Number: _________________________
Job position _____________________
+1 (425) 381-7054
robertehi@mail.com
Phone: _____________________
Email: _________________________________
23009 29th Ave W
Address: __________________________________________________________________
Brier
Town: __________________
98036
Washington
Zip: ______________________________
State: ____________________________
Authorizer details
Jim Mortimer
Regional Division Director
Full Name: ___________________________________
Title: _______________________
Boeing Capital Corporation
Company: _____________________________
Designation ________________________
+1 (206) 655-2121
jimmort@boeing.com
Phone: ______________________
Email: _______________________________
7755 E Marginal Way S
Address: ___________________________________________
Seattle
98108
Washington
Town: ____________________
Zip: ____________________
State: ____________________
Jim Mortimer
I hereby authorize _____________________________
to employ the above named person on
powers bestowed to me by the state of ______________________ as a district parole officer.
08/06/2016
Signature ___________________________ Date ___________________________