Employment Eligibility Verification Form I-9

Employment Eligibility Verification Department of Homeland Security

U.S. Citizenship and Immigration Services USCIS Form I-9 OMB 1615-0047
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.

Instructions are available here: https://www.uscis.gov/sites/default/files/document/forms/i-9instr.pdf

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) anemployee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because thedocumentation presented has a future expiration date may also constitute illegal discrimination.
Last Name (Family Name)*
First Name (Given Name)*
Middle Initial
Other Last Names Used (If any)
Address (Street Number and Name)*
Apartment Number
City or Town*
State*
Zip Code*
Date of Birth*
mm/dd/yyyy
U.S. Social Security Number*
Employee's E-mail Address*
Employee's Telephone Number*
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents inconnection 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 States2. A noncitizen national of the United States (See Instructions)3. A lawful permanent resident4. An alien authorized to work
Alien Registration Number/USCIS Number:
An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy) Some aliens may write "N/A" in the expiration date field.
mm/dd/yyyy
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.
Alien Registration Number/USCIS Number
Form I-94 Admission Number
Foreign Passport Number
Country of Issuance
Signature of Employee*

Clear
Date*

MonthDayYear
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
Date

MonthDayYear
Date
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
Zip Code
Should be Empty:

Employment Eligibility Verification Department of Homeland Security