Application for Employment

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.

ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national original may be illegal.

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 (if any)

Other Last Names Used (if any)

* Address (Street Number and Name)

Unit No.

* City or Town / State

* Zip Code

* Date of Birth

* Social Security Number

* Email Address

* Phone Number

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 USCIX or A-Number)

4. An alient authorized to work until (exp. date, if any)

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

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3. Please download the form above and upload as an attachment.

* 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.

* Signature

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USCIS Form I-9

Employment Eligibility Verification

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.