USCIS Form I 9

Transcript

1 USCIS Employment Eligibility Verification Form I-9 Department of Homeland Security OMB No. 1615-0047 U.S. Citizenship and Immigration Services Expires 08/31/2019 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, ► Employers are liable for errors in the completion of this form. during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to empl oy an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later , but not before accepting a job offer.) first day of employment than the Middle Initial First Name (Given Name) Other Last Names Used Last Name (if any) (Family Name) State Apt. Number City or Town ZIP Code (Street Number and Name) Address Employee's Telephone Number Date of Birth (mm/dd/yyyy) Employee's E-mail Address U.S. Social Security Number - - I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. 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 (Alien Registration Number/USCIS Number): (expiration date, if applicable, mm/dd/yyyy): 4. An alien authorized to work until Some aliens may write "N/A" in the expiration date field. (See instructions) QR Code - Section 1 Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: Do Not Write In This Space An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. Alien Registration Number/USCIS Number: 1. OR 2. Form I-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance: Signature of Employee Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): A preparer(s) and/or translator(s) assisted the employee in completing Section 1. I did not use a preparer or translator. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) 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. Today's Date (mm/dd/yyyy) Signature of Preparer or Translator Last Name (Family Name) First Name (Given Name) State ZIP Code City or Town Address (Street Number and Name) Employer Completes Next Page Page 1 of 3 Form I-9 07/17/17 N

2 USCIS Employment Eligibility Verification Form I-9 Department of Homeland Security OMB No. 1615-0047 U.S. Citizenship and Immigration Services Expires 08/31/2019 Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first d ay of employment. You isted on the "Lists must physically examine one document from List A OR a combination of one document from List B and one document from List C as l of Acceptable Documents.") M.I. First Name Last Name (Given Name) (Family Name) Citizenship/Immigration Status Employee Info from Section 1 List B List A List C OR AND Identity Identity and Employment Authorization Employment Authorization Document Title Document Title Document Title Issuing Authority Issuing Authority Issuing Authority Document Number Document Number Document Number (if any)(mm/dd/yyyy) Expiration Date (if any)(mm/dd/yyyy) Expiration Date Expiration Date (if any)(mm/dd/yyyy) Document Title QR Code - Sections 2 & 3 Issuing Authority Additional Information Do Not Write In This Space Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number (if any)(mm/dd/yyyy) Expiration Date : I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, Certification the (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 employee is authorized to work in the United States. (mm/dd/yyyy) The employee's first day of employment : (See instructions for exemptions) Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Title of Employer or Authorized Representative First Name of Employer or Authorized Representative Last Name of Employer or Authorized Representative Employer's Business or Organization Name State City or Town ZIP Code Employer's Business or Organization Address (Street Number and Name) Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) (if applicable) Date of Rehire B. (Family Name) Last Name (Given Name) First Name Middle Initial Date (mm/dd/yyyy) hat establishes C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt t continuing employment authorization in the space provided below. Document Number Document Title Expiration Date (if any ) (mm/dd/yyyy) 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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative (mm/dd/yyyy) Today's Date Name of Employer or Authorized Representative Page 2 of 3 Form I-9 07/17/17 N

3 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. LIST A LIST C LIST B Documents that Establish Documents that Establish Documents that Establish Employment Authorization Identity Both Identity and Employment Authorization OR AND U.S. Passport or U.S. Passport Card 1. 1. Driver's license or ID card issued by a A Social Security Account Number 1. includes one of State or outlying possession of the card, unless the card 2. Permanent Resident Card or Alien United States provided it contains a the following restrictions: Registration Receipt Card (Form I-551) photograph or information such as (1) NOT VALID FOR EMPLOYMENT name, date of birth, gender, height, eye 3. Foreign passport that contains a (2) VALID FOR WORK ONLY WITH color, and address temporary I-551 stamp or temporary INS AUTHORIZATION I-551 printed notation on a machine- 2. ID card issued by federal, state or local (3) VALID FOR WORK ONLY WITH readable immigrant visa government agencies or entities, DHS AUTHORIZATION provided it contains a photograph or 4. Employment Authorization Document 2. Certification of report of birth issued information such as name, date of birth, that contains a photograph (Form by the Department of State (Forms gender, height, eye color, and address I-766) DS-1350, FS-545, FS-240) 3. School ID card with a photograph 3. Original or certified copy of birth For a nonimmigrant alien authorized 5. certificate issued by a State, Voter's registration card 4. to work for a specific employer county, municipal authority, or because of his or her status: U.S. Military card or draft record 5. territory of the United States Foreign passport; and a. bearing an official seal Military dependent's ID card 6. b. Form I-94 or Form I-94A that has Native American tribal document 4. the following: 7. U.S. Coast Guard Merchant Mariner Card (1) The same name as the passport; U.S. Citizen ID Card (Form I-197) 5. and Native American tribal document 8. 6. Identification Card for Use of (2) An endorsement of the alien's Resident Citizen in the United 9. Driver's license issued by a Canadian nonimmigrant status as long as States (Form I-179) government authority that period of endorsement has not yet expired and the Employment authorization 7. For persons under age 18 who are proposed employment is not in document issued by the conflict with any restrictions or unable to present a document Department of Homeland Security limitations identified on the form. listed above: 6. Passport from the Federated States of 10. School record or report card Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form Clinic, doctor, or hospital record 11. I-94 or Form I-94A indicating 12. Day-care or nursery school record nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 07/17/17 N Page 3 of 3

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