Form i-9

Employment Eligibility Verification

USCIS Form I-9
Section 1. Employee Information and Attestation

ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.
Employee Last Name (Family Name)*
Employee 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
Check one of the following boxes to attest to your citizenship or immigration status See page 2 and 3 of the instructions*

1. US Citizen2. US Non-Citizen National3. Permanent Resident4. Non-Citizen [Other than Items 2 or 3 Above] authorized to work until: (exp. if any)
3. Enter USCIS or A-Number
4. Authorized to work until (exp. date, if any)

MonthDayYear
Date
If you check Item Number 4., enter one of these:
USCIS A-Number
Form I-94 Admission Number
OR
Foreign Passport Number and Country of Issuance
OR
Today's Date (mm/dd/yyyy)*

MonthDayYear
Date
Signature*

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LISTS OF ACCEPTABLE DOCUMENTS
Employees may present:

(1 item from List A)

- or -

(1 item from List B - AND - 1 item from List C)

All documents containing an expiration date must be unexpired.
List A Document
Issuing Authority
Document Number (if any)
Expiration Date (if any)

MonthDayYear
Date
File Upload

Cancelof
OR
List B Document
Issuing Authority
Document Number (if any)
Expiration Date (if any)

MonthDayYear
Date
File Upload

Cancelof
AND
List C Document
Social Security Card MUST NOT say "NOT VALID", or "VALID FOR WORK ONLY WITH AUTHORIZATION". If so, option 7 or another document must also be presented and not expired.
Issuing Authority
Document Number (if any)
Expiration Date (if any)

MonthDayYear
Date
File Upload

Cancelof
Additional Information (if needed)
First Day of Employment (mm/dd/yyyy)
Last Name, First Name and Title of Employer or Authorized Representative
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Employer's Business or Organization Name
Employer's Business or Organization Address, City or Town, State, ZIP Code
Did a translator or preparer help you fill this i9 out?*

YesNo
Supplement A, Preparer and/or Translator Certification for Section 1
Form I-9 Supplement A
U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 05/31/2027
Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's completed Form I-9.

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.
Employee Name

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

First Name (Given Name)Middle Initial (if any)Last Name (Family Name)
Signature of Preparer or Translator

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Date (mm/dd/yyyy)

MonthDayYear
Date
Translator Address

Address (Street Number and Name)

Street Address Line 2

City or TownState / Province

Postal / Zip Code
Translator State
Translator ZIP Code
Is employee being rehired (within 3 years)?*

YesNo
Supplement B, Reverification and Rehire (formerly Section 3)
U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 05/31/2027
Employee Name

First Name (Given Name) from Section 1.Middle initial (if any) from Section 1.Last Name (Family Name) from Section 1.
Date of Rehire (mm/dd/yyyy)

MonthDayYear
Date
Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.
Document Title
Document Number (if any)
Expiration Date (if any) (mm/dd/yyyy)

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
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Additional Information Initial and date each notation

MonthDayYear
Date
Should be Empty:

Employment Eligibility Verification

USCIS A-Number

Form I-94 Admission Number

Foreign Passport Number and Country of Issuance

LISTS OF ACCEPTABLE DOCUMENTS

OR

AND

Form I-9 Supplement A

Supplement B, Reverification and Rehire (formerly Section 3)