Employment Eligibility Verification

U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 10/31/2022

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

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. 

OR

OR

(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.

U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 10/31/2022

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 a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

Expiration Date (if any) (mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

(See instructions for exemptions)

Title of Employer or Authorized Representative

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

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

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.

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

1.Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

1.A Social Security Account Number card, unless the card includes one of the following restrictions:

(1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

4.Employment Authorization Document that contains a photograph (Form

2.ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address

2.Certification of report of birth issued by the Department of State (Forms

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.

3.School ID card with a photograph

5.U.S. Military card or draft record

6.Military dependent's ID card

3.Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

7.U.S. Coast Guard Merchant Mariner Card

4.Native American tribal document

5.U.S. Citizen ID Card (Form I-197)

8.Native American tribal document

9.Driver's license issued by a Canadian government authority

6.Identification Card for Use of Resident Citizen in the United States (Form I-179)

For persons under age 18 who are unable to present a document listed above:

7.Employment authorization document issued by the

Department of Homeland Security

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

10.School record or report card

11.Clinic, doctor, or hospital record

12.Day-care or nursery school record

Examples of many of these documents appear in the Handbook for Employers (M-274

Refer to the instructions for more information about acceptable receipts.

Form I-9 10/21/2019 - Form Made Fillable by eForms