Form I-9 Department of Homeland SecurityU.S. Citizenship and Immigration ServicesUSCISForm I-9OMB No. 1615-0047Expires 07/31/2026 Click for Instructions FORM I-9 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 Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Date of Birth U.S. Social Security Number Employee's Email Employee's Telephone Number I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct. Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Enter USCIS or A-Number) 4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any) until (expiration date, if applicable, mm/dd/yyyy): USCIS Number or A-Number If you check Item Number 4., enter one of these: USCIS A-Number Form I-94 Admission Number Foreign Passport Number and Country of Issuance Signature of Employee signature keyboard Clear Today's Date Preparer and/or Translator Certification for Section 1 If a preparer and/or translator assisted you in completing Section 1, that person MUST complete this Preparer and/or Translator Certification. Please Check One I did not use a preparer or translator A preparer(s) and/or translator(s) assisted the employee in completing Section 1. Instructions: This section must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9. Each preparer or translator must complete, sign, and date a separate certification area. 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 signature keyboard Clear Today's Date Last Name (Family Name) of preparer/translator First Name (Given Name) of preparer/translator Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal 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 - IDENTITY AND EMPLOYMENT AUTHORIZATION Document Title Issuing Authority Document Number Expiration Date (if any) Document Title Issuing Authority Document Number Expiration Date (if any) Document Title Issuing Authority Document Number Expiration Date (if any) LIST B - IDENTITY Document Title Issuing Authority Document Number Expiration Date (if any) LIST C - EMPLOYMENT AUTHORIZATION Document Title Issuing Authority Document Number Expiration Date (if any) EMPLOYER SIGNATURE Signature signature keyboard Clear Today's Date 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 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 applicable) Last Name (Family Name) First Name (Given Name) Middle Initial B. Date of Rehire (if applicable) Date 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) Submit If you are human, leave this field blank.
