Employment Eligibility Verification Form
Complete this form to verify your employment eligibility and provide necessary documentation.
Employment Eligibility Verification USCIS 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.
Start Here: Employers must ensure the form is completed by the employee no later than the first day of employment, but not before accepting a job offer. Anti-Discrimination Notice: It is illegal to discriminate against work-authorized individuals. For more information, visit www.justice.gov/crt/immigrant-and-employee-rights-section.
Section 1. Employee Information and Attestation
Last Name (Family Name)
*
First Name (Given Name)
*
Middle Initial
Other Last Names Used (if any)
Address (Street Number and Name)
*
Apt. Number
City or Town
*
State (Two-Letter Abbreviation)
*
ZIP Code
*
Date of Birth
*
-
Month
-
Day
Year
Date
U.S. Social Security Number
*
Employee's Email Address
example@example.com
Employee's Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I attest, under penalty of perjury, that I am authorized to work in the United States.
*
I attest to my employment authorization
I attest, under penalty of perjury, that I am (check one of the following boxes):
1. I am a citizen of the United States
2. A non citizen national of the United States(See Instructions).
3. A lawful permanent resident
4. An alien authorized to work
Employee Signature (Draw or sign below)
*
Date
*
-
Month
-
Day
Year
Date
Document Presentation (Complete EITHER List A OR List B and List C)
List A Document Entry 1
Document Title (List A - 1)
Issuing Authority (List A - 1)
Document Number (List A - 1)
Expiration Date (List A - 1)
-
Month
-
Day
Year
Date
List A Document Entry 2
Document Title (List A - 2)
Issuing Authority (List A - 2)
Document Number (List A - 2)
Expiration Date (List A - 2)
-
Month
-
Day
Year
Date
List A Document Entry 3
Document Title (List A - 3)
Issuing Authority (List A - 3)
Document Number (List A - 3)
Expiration Date (List A - 3)
-
Month
-
Day
Year
Date
OR, if using List B and List C
List B Document Entry
Document Title (List B)
Issuing Authority (List B)
Document Number (List B)
Expiration Date (List B)
-
Month
-
Day
Year
Date
List C Document Entry
Document Title (List C)
Issuing Authority (List C)
Document Number (List C)
Expiration Date (List C)
-
Month
-
Day
Year
Date
DHS Alternative Procedure Used
Check if DHS alternative procedure was used
Employer or Authorized Representative Review and Certification
I attest, under penalty of perjury, that to the best of my knowledge the information above is true and correct.
First Day of Employment
*
-
Month
-
Day
Year
Date
Employer/Authorized Representative Last Name
*
Employer/Authorized Representative First Name
*
Title of Employer or Authorized Representative
*
Employer/Authorized Representative Signature (Draw or sign below)
*
Today's Date
*
-
Month
-
Day
Year
Date
Employer's Business or Organization Name
*
Employer's Business or Organization Address (Street Address)
*
City or Town (Employer Address)
*
State (Employer Address - Two-Letter Abbreviation)
*
ZIP Code (Employer Address)
*
Save
Save
Should be Empty: