EMPLOYEE I-9 FORM

Employment Eligibility Verification
USCIS
Department of Homeland Security
Form I-9
Signature*

Clear
U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 08/31/2019

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.
Name*

First NameLast Name
Middle Initial*
Other Last Names Used (if any)
Address*

Street Address

Street Address Line 2

CityState (Abbreviation)

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Employee's E mail Address*
example@example.com
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):
Select One of the Following:

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident4. An alien authorized to work
Lawful Permanent Resident Number:
Alien Registration Number / USCIS Number:
Alien Authorized to Work Until Date:

MonthDayYear
Date (if applicable)
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: 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:
OR
Country of Issuance:
Signature of Employee*

Clear
Date

MonthDayYear
Date
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

Clear
Today's Date

MonthDayYear
Date
Name of Preparer

First Name (Given Name)Last Name (Family Name)
Address (Street Number and Name)
Address

Street Address (Street Number and Name)

Street Address Line 2

CityState (Abbreviation)

Postal / Zip Code
Employment Eligibility Verification
USCIS
Department of Homeland Security
Form I-9
Employee Info from Section 1
Name

First Name (Given Name)Last Name (Family Name)
Middle Initial
Citizenship/Immigration Status
Citizen / Authorized Alien
Verification Documents

Submit a valid copy of documents listed below: Either a Valid Passport or BOTH a Valid Drivers License and a Valid Social Security Card.
Valid Passport

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Valid Driver's License*

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Valid Social Security Card*

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Birth Certificate

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Other Document

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Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

Section 1. Employee Information and Attestation

Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

Employee Info from Section 1

Verification Documents