Form I-9 Department of Homeland SecurityU.S. Citizenship and Immigration ServicesUSCISForm I-9OMB No. 1615-0047Expires 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 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 ofthis 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. 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 Address of Preparer/Translator Address of Preparer/Translator Address of Preparer/Translator City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal 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. UPLOAD DOCUMENTS File Upload Drop a file here or click to upload Choose File Maximum file size: 268.44MB Upload I-9 Documents If you are human, leave this field blank. Submit