I-9 Employment Eligibility Verification

Employment Eligibility Verification
Original Document

You are encouraged to review the original document prior to completing this form. Your answers will be embedded on the PDF form and submitted to the proper department.
Form I-9

Department of Homeland Security
U.S. Citizenship and Immigration Services

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 Name (Given Name)Middle InitialLast Name (Family Name)
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

Social Security Number

	1	2	3	4	5	6	7	8	9
Each Digit Separately

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)

1. A citizen of the United States2. A noncitizen national of the United States3. A lawful permanent resident4. An alien authroized to work
If you selected 1 or 2

Skip Sections 3 and 4
If you selected #3)
A lawful permanent resident (Alien Registration Number/USCIS Number):
If you selected #4)

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.
(expiration date, if applicable, mm/dd/yyyy)

MonthDayYear
Date
1. Alien Registration Number/USCIS Number
2. Form I-94 Admission Number
3. Foreign Passport Number
Country of Issuance
Certification and Signature
Preparer and/or Translator Certification (check one)

I did not use a preparer or translator.
Signature*

Clear
Date

MonthDayYear
Date
Upload Supporting Documentation

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Employment Eligibility Verification