I-9 Form
Data collection only. Recreate the USCIS Form I-9 (Edition 01/20/25) fields and sections faithfully using the provided PDF analysis. Do not build a Smart PDF or include payment/product fields.
Section 1: Employee Information and Attestation
Last Name (Family Name)
*
First Name (Given Name)
*
Middle Initial
Other Last Names Used
Street Number and Name
*
Apt. Number
City or Town
*
State
*
ZIP Code
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit 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.
Citizenship or Immigration Status
*
1. A citizen of the United States
2. A noncitizen national of the United States
3. A lawful permanent resident
4. An alien authorized to work until
USCIS or A-Number
Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Form I-94 Admission Number
Foreign Passport Number
Country of Issuance
Signature of Employee
*
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: