Employment Eligibility Verification
USCIS
Department of Homeland Security
Form I-9
U.S. Citizenship and Immigration Services OMB No. 1615-0047 Expires 10/31/2022START 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
Company Name
*
Name
First Name (Given Name)
Last Name (Family Name)
Middle Initial
Other Last Names Used (if any)
Address
Address (Street Number and Name)
Apt #
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
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 States
2. A noncitizen national of the United States (See instructions)
3. A lawful permanent resident
:4. An alien authorized to work until (Please enter expiration date below, if applicable, mm/dd/yyyy)
Date (if you checked item 4 above)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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.
1. Alien Registration Number/USCiS Number:
Or
2. Form I 94 Admission Number:
Or
Foreign Passport Number:
Country of Issuance:
Signature of Employee
Today's Date (mm/dd/yyyy)
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit 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 1I 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
Today's Date (mm/dd/yyyy)
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit 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
Please upload an image of one of the following: US Passport or Permanent Resident Card. If you don't have either of the above you must upload an image of a government issued ID and a Social Security Card.
*
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