Employment Eligibility Verification (I-9)

Employment Eligibility Verification

USCIS Department of Homeland Security Form I-9
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. Employers should have used Form I-9 CNMI between November 28, 2009 and November 27, 2011.
First Name (Given Name) *
Last Name (Family Name) *
Middle Initial
Other Names Used (if any)
Address (Street Number and Name) *
Apt. Number
City or Town *
State *
Zip Code *
Date of Birth (mm/dd/yyyy) *

Month Day Year
Date
U.S. Social Security Number

XXX XX XXXX
E-mail Address
example@example.com
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): *

A citizen of the United States A noncitizen national of the United States (See instructions) A lawful permanent resident (provide Alien Registration Number/USCIS Number below) An alien authorized to work until (enter expiration date, if applicable, below)
(Alien Registration Number/USCIS Number)
Work Authorization Expiration

Month Day Year
(expiration date, if applicable, mm/dd/yyyy)
(See instructions) For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form I-94 Admission Number:
Alien Registration Number/USCIS Number:
OR
Form I-94 Admission Number:
If you obtained your admission number from CBP in connection with your arrival in the United States, include the following:
Foreign Passport Number:
Country of Issuance:
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions)
Signature *

Clear
Date (mm/dd/yyyy): *

Month Day Year
Date
Preparer and/or Translator Certification

To be completed and signed if Section 1 is prepared by a person other than the employee
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator:

Clear
Date (mm/dd/yyyy):

Month Day Year
Date
Name

First Name (Given Name) Last Name (Family Name)
Address
Street Number and Name
State
Zip Code
Employer Completes Next Page
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 examine a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title, issuing authority, document number, and expiration date, if any
Employment Authorization
Employee Last Name, First Name and Middle Initial from Section 1: *
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

Documents that Establish Both Identity and Employment Authorization
1. U.S. Passport or U.S. Passport Card
2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
4. Employment Authorization Document that contains a photograph (Form I-766)
5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status:
a. Foreign passport; and

b. Form I-94 or Form I-94A that has the following:

(1) The same name as the passport; and

(2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.

6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI
Document Title:
Issuing Authority:
Document Number:
Expiration Date (if any):

Month Day Year
mm/dd/yyyy
Upload Document from List A
List B and C

Documents that Establish Identity OR Establish Employment Authorization
This section is only required if you did NOT submit documents under List A above.
Document Title:
Document Number:
Issuing Authority:
Expiration Date (if any):

Month Day Year
mm/dd/yyyy
Upload Document from List B
Document Title:
Document Number:
Issuing Authority:
Expiration Date (if any):

Month Day Year
mm/dd/yyyy
Upload Document from List C
Certification
The employee's first day of employment:
mm/dd/yyyy
Signature of Employer or Authorized Representative
Date (mm/dd/yyyy)

Month Day Year
Date
Title of Employer or Authorized Representative
Name

First Name Last Name
Employer's Business or Organization Address
Street Number and Name
Address

Employer's Business or Organization Address (Street Number and Name)

Street Address Line 2

City or Town State / Province

Postal / Zip Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative
Section 3. Reverification and Rehires

To be completed and signed by employer or authorized representative
B. Date of Rehire (if applicable) (mm/dd/yyyy):

Month Day Year
Date
C. If employee's previous grant of employment authorization has expired, provide the information for the document from List A or List C the employee presented that establishes current employment authorization in the space provided below.
New Name (if applicable)

First Name Middle Initial Last Name
Document Title:
Document Number:
Expiration Date (if any):

Month Day Year
Date
Should be Empty:

Employment Eligibility Verification

What Is the Purpose of This Form?

Preparer and/or Translator Certification

Employer Completes Next Page

Employment Authorization

List A

List B and C

Certification

Section 3. Reverification and Rehires