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Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

OMB No. 1615-0047

U.S. Citizenship and Immigration Services

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)

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 (mm/dd/yyyy)

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 boxes):

1.

A citizen of the United States

 

 

 

 

 

 

 

2.

A noncitizen national of the United States (See instructions)

 

 

 

 

 

3.

A lawful permanent resident

(Alien Registration Number/USCIS Number):

 

 

 

 

 

 

 

 

 

 

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. (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):

I did not use a preparer or translator.

 

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(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

Form I-9 10/21/2019

PagePage1 ofof4

Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

OMB No. 1615-0047

U.S. Citizenship and Immigration Services

Expires 10/31/2022

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.")

Employee Info from Section 1

Last Name (Family Name)

First Name (Given Name)

M.I.

Citizenship/Immigration Status

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issuing Authority

 

 

 

 

 

Additional Information

 

 

 

 

 

QR Code - Sections 2 & 3

 

 

 

 

 

 

 

 

 

 

 

Do Not Write In This Space

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Today's Date (mm/dd/yyyy)

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

Form I-9 10/21/2019

PagePage2 ofof4

Employment Eligibility Verification

USCIS

Department of Homeland Security

Form I-9

OMB No. 1615-0047

U.S. Citizenship and Immigration Services

Expires 10/31/2022

Employee Name from Section 1:

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

 

 

B. Date of Rehire (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Date (mm/dd/yyyy)

 

 

 

 

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

Today's Date (mm/dd/yyyy)

Name of Employer or Authorized Representative

 

 

 

Form I-9 10/21/2019

PagePage3 ofof4

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

Documents that Establish

Documents that Establish

Both Identity and

Identity

Employment Authorization

Employment Authorization

OR

AND

1.U.S. Passport or U.S. Passport Card

2.Permanent Resident Card or Alien Registration Receipt Card (Form I-551)

3.Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine- readable immigrant visa

4.Employment Authorization Document that contains a photograph (Form I-766)

5.For a nonimmigrant alien authorized to work for a specific employer because of his or her status:

a.Foreign passport; and

b.Form I-94 or Form I-94A that has the following:

(1)The same name as the passport; and

(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.

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

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

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

3.School ID card with a photograph

4.Voter's registration card

5.U.S. Military card or draft record

6.Military dependent's ID card

7.U.S. Coast Guard Merchant Mariner Card

8.Native American tribal document

9.Driver's license issued by a Canadian government authority

For persons under age 18 who are

unable to present a document

listed above:

10.School record or report card

11.Clinic, doctor, or hospital record

12.Day-care or nursery school record

1.A Social Security Account Number card, unless the card includes one of the following restrictions:

(1)NOT VALID FOR EMPLOYMENT

(2)VALID FOR WORK ONLY WITH INS AUTHORIZATION

(3)VALID FOR WORK ONLY WITH DHS AUTHORIZATION

2.Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)

3.Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

4.Native American tribal document

5.U.S. Citizen ID Card (Form I-197)

6.Identification Card for Use of Resident Citizen in the United States (Form I-179)

7.Employment authorization document issued by the Department of Homeland Security

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form I-9 10/21/2019

Page 4 of 4

Document Information

Fact Name Description
Purpose The I-9 form verifies the identity and employment authorization of individuals hired for employment in the United States.
Who Must Complete All employers must have new hires complete the I-9 form, regardless of citizenship status.
Completion Deadline Employees must complete Section 1 of the I-9 form on or before their first day of work.
Employer Responsibilities Employers must complete Section 2 within three business days of the employee's start date.
Retention Period Employers must retain the I-9 form for three years after the employee's hire date or one year after termination, whichever is longer.
State-Specific Forms Some states may have additional forms or requirements; for example, California requires the I-9 along with state-specific employment forms.
Penalties for Noncompliance Failure to properly complete and retain the I-9 form can result in fines and penalties for employers.

USCIS I-9 - Usage Guidelines

After obtaining the USCIS I-9 form, it is important to fill it out accurately to ensure compliance with employment verification requirements. The following steps will guide you through the process of completing the form correctly.

  1. Begin by entering your full name in the designated fields. This includes your last name, first name, and middle initial, if applicable.
  2. Provide your address, including street number and name, city or town, state, and ZIP code.
  3. Input your date of birth in the format requested, typically month, day, and year.
  4. Indicate your Social Security number. If you do not have one, leave this section blank, as it is not required for certain individuals.
  5. Mark the appropriate box to indicate your citizenship or immigration status. Options may include being a U.S. citizen, a noncitizen national, or a lawful permanent resident.
  6. In Section 2, your employer or authorized representative will need to fill out information regarding the documents you present for verification. This includes the document title, issuing authority, document number, and expiration date, if applicable.
  7. Both you and your employer must sign and date the form in the appropriate sections. Ensure that the dates reflect when the form is completed.

Once the form is filled out, it should be submitted to your employer for their records. Keep a copy for your own reference, as it may be needed for future employment verification processes.

Dos and Don'ts

When filling out the USCIS I-9 form, it’s important to follow specific guidelines to ensure accuracy and compliance. Here’s a list of what you should and shouldn’t do:

  • Do: Read the instructions carefully before starting.
  • Do: Use black or blue ink to fill out the form.
  • Do: Provide accurate information about your identity and employment eligibility.
  • Do: Sign and date the form after completing it.
  • Do: Keep a copy of the completed form for your records.
  • Don't: Leave any required fields blank.
  • Don't: Use correction fluid or tape on the form.
  • Don't: Provide false information or documents.
  • Don't: Submit the form after the deadline.
  • Don't: Forget to check for any updates to the form or instructions.

Common mistakes

When completing the USCIS I-9 form, individuals often encounter several common pitfalls. Understanding these mistakes can help ensure that the form is filled out correctly and efficiently. Here’s a list of seven frequent errors:

  1. Incorrect Dates: Failing to enter the correct date of hire or the date of birth can lead to complications. It is essential to double-check these dates for accuracy.

  2. Missing Signatures: Both the employee and employer must sign the form. Omitting signatures can result in the form being deemed incomplete.

  3. Wrong Document Selection: Employees must provide the correct documents to verify their identity and eligibility to work. Choosing documents that do not meet the I-9 requirements can cause delays.

  4. Inconsistent Information: Providing information that does not match the documents presented can raise red flags. Always ensure that names and details are consistent.

  5. Failure to Complete Sections: Each section of the I-9 must be filled out completely. Leaving sections blank can lead to rejection or requests for additional information.

  6. Not Using the Latest Version: The USCIS periodically updates the I-9 form. Using an outdated version can result in compliance issues.

  7. Ignoring Deadlines: There are specific timelines for completing the I-9 form. Failing to meet these deadlines can lead to penalties for employers.

By being aware of these common mistakes, individuals can navigate the I-9 form process more smoothly and ensure compliance with USCIS regulations.