NHK-I-9 FORM I-9 Department of Homeland SecurityU.S. Citizenship and Immigration ServicesUSCISForm I-9OMB No. 1615-0047Expires 07/31/2026 Click for Instructions 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, inconnection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the boxattesting 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 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 I acknowledge that signing with my electronic signature is the legal equivalent of my manual/handwritten signature on this Agreement. Today's Date Preparer and/or Translator Certification If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification section below. Check One I did not use a preparer or translator A preparer(s) and/or translator(s) assisted the employee in completing Section 1. 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. Employers must retain completed supplement sheets with the employee's completed Form I-9. 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 myknowledge 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 Middle Initial (if any) 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 Next If you are human, leave this field blank.
