START HERE
Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.
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.
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.
Last Name (Family Name)
*
First Name (Given Name)
*
Other Last Names Used (if any)
Middle Name (if any)
Street Address (Number and Name)
*
Apt. Number (if any)
City or Town
State/Province
ZIP/Postal Code
Date of Birth (MM/DD/YYYY)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
U.S. Social Security Number
*
Employee Email Address
example@example.com
Employee Telephone Number ((000) 000-0000)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Citizenship or Immigration Status (select one)
*
A citizen of the United States
A noncitizen national of the United States
A lawful permanent resident (Alien Registration Number/USCIS Number required)
An alien authorized to work (provide one of the following numbers)
USCIS A-Number (if applicable)
Form I-94 Admission Number (if applicable)
Foreign Passport Number (if applicable)
Country of Issuance (if Foreign Passport Number provided)
Today's Date (MM/DD/YYYY)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employee Attestation: I attest under penalty of perjury that the information provided is true and correct. I understand that providing false information may subject me to penalties, including perjury.
Employee Signature
*
Note: If a preparer and/or translator assisted you, they must complete the Preparer and/or Translator Certification section.
Section 2: Employer Review and Verification
Document(s) Provided (Select one option: List A OR List B and List C)
*
List A (Identity and Employment Authorization Document)
List B (Identity) AND List C (Employment Authorization)
Issuing Authority
Document Number (if any)
Expiration Date (if any, MM/DD/YYYY)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Information (if any)
Was an alternative DHS-authorized document examination procedure used?
Yes
Employer Certification: I attest under penalty of perjury that I have examined the documentation presented by the above-named employee, and to the best of my knowledge, the employee is authorized to work in the United States.
Employer Signature
*
First Day of Employment (MM/DD/YYYY)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: