Employment Eligibility Verification

Employment Eligibility Verification
USCIS
Department of Homeland Security
Form I-9
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
Middle Initial
Other Last Names Used (if any)
Apt. Number
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
U.S. Social Security Number
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):
(Alien Registration Number/USCIS Number):

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident(expiration date, if applicable, mm/dd/yyyy): 4. An alien authorized to work until
Some aliens may write "N/A" in the expiration date field. (See instructions) 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.

QR Code - Section 1 Do Not Write In This Space

1. Alien Registration Number/USCIS Number:
1. Alien Registration Number/USCiS Number:
2. Form I 94 Admission Number:
Foreign Passport Number:
Country of Issuance:
Signature of Employee

Clear
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)

MonthDayYear
Date
Name

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

Address (Street Number and Name)

Street Address Line 2

City or TownState

ZIP Code
Employment Eligibility Verification
USCIS
Department of Homeland Security
Form I-9
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.")
Employee Info from Section 1
Name

First Name (Given Name)Last Name (Family Name)
M.I.
Citizenship/Immigration Status
List A Identity and Employment Authorization
List B Identity
AND
List C Employment Authorization
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

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

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

MonthDayYear
Date
QR Code - Sections 2 & 3 Do Not Write In This Space

Expiration Date (if any) (mm/dd/yyyy)
Additional Information
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.
The employee's first day of employment (mm/dd/yyyy):
(See instructions for exemptions)
Title of Employer or Authorized Representative
Name

Employer's Business or Organization NameLast Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Address

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

Street Address Line 2

City or TownState

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

B. Date of Rehire (if applicable)
Middle Initial
Date (mm/dd/yyyy)

MonthDayYear
Date
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.

Signature of Employer or Authorized Representative
Signature of Employer or Authorized Representative

Clear
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Name of Employer or Authorized Representative
LISTS OF ACCEPTABLE DOCUMENTS
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
LIST B
LIST C
Documents that Establish Both Identity and Employment Authorization
Documents that Establish Identity
Documents that Establish Employment Authorization
AND
1. U.S. Passport or U.S. Passport Card

2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

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

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) 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

3. School ID card with a photograph

4. Voter's registration card

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

conflict with any restrictions or

7. Employment authorization document issued by the

limitations identified on the form.

6. Passport from the Federated States

of Micronesia (FSM) or the Republic

10. School record or report card

of the Marshall Islands (RMI) with

11. Clinic, doctor, or hospital record

Form I-94 or Form I-94A indicating

nonimmigrant admission under the

12. Day-care or nursery school record

Compact of Free Association Between

the United States and the FSM or RMI
7. Employment authorization document issued by the Department of Homeland Security
Department of Homeland Security

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

Refer to the instructions for more information about acceptable receipts.
Should be Empty:

Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

Employee Info from Section 1

List A Identity and Employment Authorization

List B Identity

AND

List C Employment Authorization

LISTS OF ACCEPTABLE DOCUMENTS

LIST A

LIST B

LIST C

Documents that Establish Both Identity and Employment Authorization

Documents that Establish Identity

Documents that Establish Employment Authorization

AND