I-9 Form

Employment Eligibility Verification
Department of Homeland Security
Form I-9
U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 10/31/2022

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)
Name

First Name (Given Name)Middle InitialOther Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
Social Security Number
Employee's E-mail Address
example@example.com
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 boxes)

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident (Alien Registration Number/USCIS Number):
3. A lawful permanent resident (Alien Registration Number/USCIS Number)
4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy)
4. An alien authorized to work until(expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field.

MonthDayYear
Date
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
Signature of Employee

Clear
Date

MonthDayYear
Date
To be filled out if prepared by a translator:
Signature of Preparer or Translator

Clear
Date

MonthDayYear
Date
Name

First Name (Given Name)Last Name (Family Name)
Address

Address (Street Number and Name)

Street Address Line 2

City or TownState / Province

Postal / Zip Code
State
ZIP Code
Should be Empty:

Employment Eligibility Verification

Department of Homeland Security

Form I-9

To be filled out if prepared by a translator: