Employment Eligibility Verification

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.)
First and Last Names *

First Name (Given Name) Last Name (Family Name)
Middle Initial
Other Last Names Used (if any)
Address

Street Address

Apt Number or Street Address Line 2

City State / Province

Postal / Zip Code
Date of Birth (mm/dd/yyyy)

Month Day Year
Date

U.S. Social Security Number

	Number	Number	Number	Number	Number	Number	Number	Number	Number
1 number per box. No dashes.

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): *

1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident 4. An alien authorized to work until (fill in expiration date below if applicable)
Alien Registration Number/USCIS Number:
Expiration date of authorization to work

Month Day Year
Some aliens may skip this field (See Form I-9 instructions).
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alient 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:
Foreign Passport Number - Country of Issuance
Signature of Employee *

Clear
Date *

Month Day Year
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 (mm/dd/yyyy)

Month Day Year
Date
Name

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

Address (Street Number and Name)

Street Address Line 2

City or Town State

ZIP Code
Should be Empty:

Section 1. Employee Information and Attestation