I-9 Form

Employment Eligibility Verification

USCIS Form I-9
U.S. Citizenship and Immigration Services OMB No. 1615-0047 Expires 08/31/2019

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.
Name*

First NameMiddle InitialLast Name
Other Last Names Used (if any)
Address*

Street Address

Street Address Line 2

CityState (Abbreviation)

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
U.S. Social Security Number
Employee's E mail Address
example@example.com
Employee Phone Number
Position
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):
Select One of the Following:*

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident4. An alien authorized to work
Alien Authorized to Work Until Date:

MonthDayYear
Date (if applicable)
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.
USCIS A-Number:
OR
Form I 94 Admission Number:
OR
Foreign Passport Number:
Country of Issuance:
Signature of Employee*

Clear
Date

MonthDayYear
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

MonthDayYear
Date
Name of Preparer

First Name (Given Name)Last Name (Family Name)
Address (Street Number and Name)
Address

Street Address (Street Number and Name)

Street Address Line 2

CityState (Abbreviation)

Postal / Zip Code
SS D1
SS D2
SS D3
SS D4
SS D5
SS D6
SS D7
SS D8
SS D9
Employment Eligibility Verification
Please upload Driver's License or ID - Only upload a passport if you are not an Illinois Resident*

Browse Files

Cancelof
Please upload Social Security Card

Browse Files

Cancelof
List A Doc Title
List A Issuing Auth
List A Doc Number
List A Expiration
List B Doc Title
List B Issuing Auth
List B Number
List B Expire
List C Doc Title
List C Issuing Auth
List C Number
Employer Address
Employer City
Employer State
Employer Zip
Last Name
First Name
Title of Employer
Business Name
Date Signed

MonthDayYear
Date
Date Started

MonthDayYear
Date
Signature

Clear
Production Company
Project Title
Loan Out Name
Loan Out FEIN
Loan Out Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Employment Eligibility Verification

Section 1. Employee Information and Attestation

Employment Eligibility Verification