Uscis Form I-9 - Employment Eligibility Verification
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1Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form 1-9
OMB
No.
1615-0047
Expires
03/3112016
~START
HERE.
Read instructions
carefully
before completing
this form. The instructions
must be available during completion
of this
form.
ANTI·DISCRIMINATION
NOTICE:
It is illegal to discriminate
against work-authorized
individuals.
Employers
CANNOT
specify which
document(s)
they will accept from an employee.
The refusal to hire 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 1-9 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 Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
Zip Code
~
Date of Birth (mm/dd/yyyy)
r
s
'
SOI~r sel~[Numbn
E-mail Address
Telephone Number
I am aware that federal law provides for imprisonment
andlor
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):
D
A citizen of the United States
D
A noncitizen
national
of the United States (See instructions)
D
A lawful permanent
resident
(Alien Registration
Number/USCIS
Number):
_
D
An alien authorized to work until (expiration
date,
if
applicable,
mm/dd/yyyy)
. Some aliens may write "N/A" in this field.
(See instructions)
For aliens authorized
to
work,
provide
your Alien Registration
Number/USCIS
Number
OR Form 1-94 Admission
Number:
1.
Alien Registration
Number/USCIS
Number:
_
OR
3·D Barcode
Do Not Write in This Space
If you obtained
your admission
number
from CBP in connection
with your arrival in the United
States,
include the
following:
2.
Form
1-94
Admission
Number:
_
Foreign Passport
Number:
------
Country of Issuance:
_
Some aliens may write "N/A" on the Foreign
Passport
Number
and Country
of Issuance
fields.
(See instructions)
Signature of
Employee:
Date
(mm/dd/yyyy):
Preparer and/or'Tliilnslator Certification
(To.be completed
and siqneditSection
tis
prepared
by apersonotherthan
the
employee.)
.
.
.
...
. .
. .. .. .
.
I
attest,
under penalty of
perjury,
that I have assisted in the completion of this form and that to the best of my knowledge the
information is true and correct.
Signature of Preparer or
Translator:
I
Date
(mm/dd/yyyy):
Last Name (Family
Name)
First Name (Given Name)
Address (Street Number and Name)
I
City or Town
I
State
...
I
Zip Code
[iJ
:~,
Form I-9
03/08/13 N
Page 7 of9
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