Form I-9 – MPS

Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-9
OMB No. 1615-0047
Expires 07/31/2026

FORM I-9

View 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

City

State/Province

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.

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 (Enter USCIS or A-Number.)

4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)

Enter USCIS or A-Number:

until (expiration date, if applicable, mm/dd/yyyy):

If you check Item Number 4., enter one of the following:

USCIS A-Number

Form I-94 Admission Number

Foreign Passport Number

Country of Issuance

for Foreign Passport

Signature Required

Signature of Employee *

Clear

Today's Date

Preparer and/or Translator Certification

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete this section.

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 my knowledge the information is true and correct.

Signature of Preparer or Translator

Clear

Today's Date

Last Name (Family Name) of Prep/Trans

of preparer/translator

First Name (Given Name) of Prep/Trans

of preparer/translator

Middle Initial (if any)

of preparer/translator

Address of Preparer/Translator

City

State/Province

Zip/Postal

ATTENTION:

Your employer is required to verify your documents and complete section 2 of this form. Is your employer present? *

YES employer present. (they will fill out remainder of form)

NO employer not present (skip Section 2 and submit forms)

Section 2. Employer Review and Verification

Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; See Instructions.

View Instructions

Employee Info from Section 1

Last Name (Family Name)

First Name (Given Name)

M.I.

Citizenship/Immigration Status

Lists of Acceptable Documents Click Here

Please Select the Appropriate Document List(s)

List A

List B and List C

LIST A - Documents that Establish Both 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 - Documents that Establish Identity

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

LIST C - Documents that Establish Employment Authorization

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

Additional Information

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:

(See instructions for exemptions)

Signature of Employer or Authorized Representative *

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

Supplement B - Reverification and Rehire

This supplement B section replaces Section 3 on the previous version of Form I-9. Only complete this section if your employee requires reverification, is rehired within three years of the date the original Form I-9 was completed, or provides proof of a legal name change.

Review the Form I-9 instructions before completing this section. Keep this page as part of the employee's Form I-9 record. Additional guidance can be found in the Handbook for Employers: Guidance for Completing Form I-9 (M-274).

Choose One:

Yes, I need to complete Supplement B

No, I do not I need to complete Supplement B

Date of Rehire (if applicable)

New Name (if applicable):

New Last Name (Family Name)

New First Name (Given Name)

New Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.

Document Title

Document Number

Expiration Date (if any)

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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.

Name of Employer or Authorized Representative

Signature of Employer or Authorized Representative

Clear

only needed if Section 3 was completed

Date

Additional Information (Initial and date each notation.)

Checkboxes

Check here if you used an alternative procedure authorized by DHS to examine documents.

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