Employment Eligibility Verification

Employment Eligibility Verification
USCIS
Department of Homeland Security
Last Name (Family Name)*
Name*

First Name (Given Name)Middle Initial (if any)Other Last Names Used (if any)
Address (Street Number and Name)*
Apt. Number (if any)
City or Town*
State*
ZIP Code*
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
U.S. Social Security Number*
Employee's Email Address*
example@example.com
Employee's Telephone Number*
I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.
Check one of the following boxes to attest to your citizenship or immigration status See page 2 and 3 of the instructions*

1. A citizen of the United States2. A noncitizen national of the United States See Instructions3. A lawful permanent resident Enter USCIS or A-Number4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)
Only complete this section if you checked Item 4 above. Enter one of the following below:
- USCIS A-Number
- Form I-94 Admission Number F
- Foreign Passport Number and Country of Issuance.
If you checked Item 4 above, enter one of the following:

USCIS A-NumberForm I-94 Admission NumberLast Name (Family Name)
Below you will find a list of acceptable documents for verifying your eligibility for emploment. Please upload:

One document from List A, (such as a passport)

OR

One document from List B and one document from List C (such as driver's license and social security card or birth certificate).

If you are having difficulty uploading, you may email the documents to coordinator@eventsbymarylee.com.
File Upload

Cancelof
Signature*

Clear
Today's Date (mm/dd/yyyy)*

MonthDayYear
Date
Did you used a preparer or translator to assist you in completing this form?*

YesNo

If you used a Preparer or Translator to complete the I-9 Form then the preparer/translator must complete this section.
Name

First Name (Given Name) from Section 1.Middle initial (if any) from Section 1.Last Name (Family Name) from Section 1.
Signature of Preparer of Translator

Clear
Date (mm/dd/yyyy)

MonthDayYear
Date
Name

First Name (Given Name)Middle Initial (if any)Last Name (Family Name)
Address

Address (Street Number and Name)

Street Address Line 2

City or TownState / Province

Postal / Zip Code
State
ZIP Code

Should be Empty:

Employment Eligibility Verification

USCIS

Department of Homeland Security

If you used a Preparer or Translator to complete the I-9 Form then the preparer/translator must complete this section.