Employment Eligibility Verification USCIS
Form I-9
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0047
Expires 08/31/2019

►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.
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) Middle Initial Other Last Names Used (if any)
Address (Street Number and Name) Apt. Number City or Town State Zip Code
Date of Birth (month/day/year) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following):

   Some aliens may write "N/A" in the expiration date field. (See instructions)
  Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
  1. Alien Registration Number/USCIS Number:
  OR
  2. Form I-94 Admission Number:
  OR
  3. Foreign Passport Number:
        Country of Issuance:  
 
 

QR Code - Section 1
Do Not Write in This Space
Signature of Employee: Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification(check one):
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
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.
Signature of Preparer or Translator: Today's Date (mm/dd/yyyy)
Last Name (Family Name) First Name (Given Name)
Address (Street Number and Name) City or Town State Zip Code

Employer Completes Next Page
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Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")



List A OR List B AND List C
Identity and Employment Authorization Identity Employment Authorization

Document Title:
  Document Title:
  Document Title:
Issuing Authority:
  Issuing Authority:
  Issuing Authority:
Document Number:
  Document Number:
  Document Number:
Expiration Date (if any)(mm/dd/yyyy):
  Expiration Date (if any)(mm/dd/yyyy):
  Expiration Date (if any)(mm/dd/yyyy):
Document Title:
   

Additional Information

QR Code - Sections 2 & 3
Do Not Write in This Space
Issuing Authority:
 
Document Number:
 
Expiration Date (if any)(mm/dd/yyyy):
 
Document Title:
 
Issuing Authority:
 
Document Number:
 
Expiration Date (if any)(mm/dd/yyyy):
 

CERTIFICATION
I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions.)
Signature of Employer or Authorized Representative Date (month/day/year) Title of Employer or Authorized Representative
Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name) City or Town State Zip Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicabble) B. Date of Rehire (month/day/year) (if applicable)


C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
  Document Title: Document Number: Expiration Date (if any)(mm/dd/yyyy):

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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
 
Signature of Employer or Authorized Representative Date (month/day/year) Print Name of Employer or Authorized Representative:
 
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LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.
LIST A LIST B LIST C
Documents that Establish Both Documents that Establish Documents that Establish
Identity and Employment Identity Employment Authorization
Authorization    
  O R A N D  
1. U.S. Passport or U.S. Passport Card 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 1. A Social Security Account Number card, unless the card includes one of the following restrictions:
2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)   (1) NOT VALID FOR EMPLOYMENT
3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machinereadable immigrant visa 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address   (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION
  (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION
4. Employment Authorization Document that contains a photograph (Form I-766) 3. School ID card with a photograph 2. Certification of Birth Abroad issued by the Department of State (Form FS-545)
4. Voter's registration card
5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status: 5. U.S. Military card or draft record 3. Certification of Report of Birth issued by the Department of State (Form DS-1350)
a. Foreign passport; 6. Military dependent's ID card 4. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal
b. Form I-94 or Form I-94A that has the following: 7. U.S. Coast Guard Merchant Mariner Card
  (1) The same name as the passport;
and
8. Native American tribal document
  (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. 9. Driver's license issued by a Canadian government authority 5. Native American tribal document
  For persons under age 18 who are unable to present a document listed above: 6. U.S. Citizen ID Card (Form I-197)
6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI 10. School record or report card 7. Identification Card for Use of Resident Citizen in the United States (Form I-179)
11. Clinic, doctor, or hospital record 8. Employment authorization document issued by the Department of Homeland Security
12. Day-care or nursery school record

Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274).
 
Refer to the instructions for more information about acceptable receipts.
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