Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0047
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)
Preparer and/or Translator Certification
If a preparer and/or translator assisted you in completing Section 1, that person MUST complete this section.
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.
Address of Preparer/Translator
Your employer is required to verify your documents and complete section 2 of this form. Is your employer present?
Please Select the Appropriate Document List(s)
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.
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