I-9 Form

Employment Eligibility Verification

Please fill out Section 1 ONLY.
Center*
Section 1. Employee Information and Attestation

Employees must complete and sign Section of Form no later than the first day of employment, but not before accepting a job offer.
Name*

Last Name Given NameMiddle Initial
Other Last Names Used

If any
Address (Street Number and Name)*
Apt. Number
City or Town*
State*
ZIP Code*
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
U.S. Social Security Number*
First three digits
U.S. Social Security Number*
Second two digits
U.S. Social Security Number*
Last four digits
Employee's E-mail Address*
example@example.com
Employee's Telephone Number
Format: (000) 000-0000.
1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident (Alien Registration Number/USCIS Number):4. An alien authorized to work
3. A lawful permanent resident (Alien Registration Number/USCIS Number)
Date

MonthDayYear
Date
If you check item number 4. Enter one of these:
1. Alien Registration Number/USCIS Number:
2. Form I-94 Admission Number
3. Foreign Passport Number
Signature of the employee

Clear
Date

MonthDayYear
Date

Reverification and Rehire

Only use this page if you are
Name

Last NameFirst NameMiddle Initial
Date of Rehire (if applicable)

MonthDayYear
Date
Name

Last NameFirst NameMiddle Initial
Document Title
Document Number (if any)
Expiration Date

MonthDayYear
Date
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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

First NameLast Name
Signature of Employer or Authorized Representative

Clear
Date

MonthDayYear
Date
Additional information (initial and date each notation)
YesNo
Date Rehire

MonthDayYear
Date
Name

Last NameFirst NameMiddle Initial
Document Title
Document Number
Expiration Date

MonthDayYear
Date
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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

First NameLast Name
Signature of Employer or Authorized Representative

Clear
Date

MonthDayYear
Date
Additional information (initial and date each notation)
YesNo
Date Rehire

MonthDayYear
Date
Name

Last NameFirst NameMiddle Initial
Document Title
Document Number
Expiration Date

MonthDayYear
Date
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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Additional information (initial and date each notation)
YesNo
Should be Empty:

Employment Eligibility Verification

Section 1. Employee Information and Attestation

Reverification and Rehire