Form I-9

Employer/Employee

Who is filling this out?

Who is filling this out? EmployerEmployee

Employees must fill out sections marked "Employee" after accepting a job offer, but no later than the first day of employment

Employees must fill out sections marked "Employee" after accepting a job offer, but no later than the first day of employment I understand

Employer Information

Last Name, First Name, and Title of Employer or Authorized Representative

Employers may provide this information in the form of the following example:
Mills, Mary: Owner
An authorized representative is someone the employer designates to fill out the form on their behalf, and may provide information in the form of the following example:
Green, Kevin: Employer's Authorized Representative

Employer's Business or Organization Name

Business or Organization Address

Provide in the following format:

Street name and number, unit number (if any), city or town, state, ZIP code

Employer: e-Verify

Do you participate in e-Verify?

Do you participate in e-Verify? YesNo

Only employers who participate in the government's e-Verify program are eligible to review an employee's required employment documents remotely. Participation is not required, but employers who are not enrolled in e-Verify must conduct a physical inspection of the employee identity and work eligibility documents addressed later in this form.

Employee: Name

First Name

Last Name

Middle Initial

If none, leave blank

Employee Other Last Names Used (if any)

If none, leave blank

Employee: Address

Street Number and Name

Apartment or Unit Number

If none, leave blank

City or Town

State

Please select some item.

ZIP Code

Employee: Contact

Phone Number

E-mail Address

Employee: Personal Information

Date of Birth

Social Security Number

Providing a Social Security Number is not required unless your employer participates in the E-Verify program. If you are unsure whether your employer participates in E-Verify, contact them and leave blank until you find out.

Employee: Citizenship or Immigration Status

Citizenship/immigration status

Citizenship/immigration status U.S. CitizenNoncitizen U.S. nationalLawful permanent residentNone of the above

Those who are authorized to work but are neither citizens, nationals, nor lawful permanent residents should select "None of the above."

USCIS or A-Number

Expiration Date of Work Authorization

Provide the date on which the document authorizing you to work, such as an approved I-765, expires. Provide in the following format:
mm/dd/yyyy

Those whose employment authorization does not have an expiration date, including refugees and asylees, should write "N/A."

Select one of the following means of identification that you will be able to provide

Select one of the following means of identification that you will be able to provide USCIS A-NumberForm I-94 Admission NumberForeign Passport Number

USCIS A Number

A-

Form I-94 Admission Number

Foreign Passport Number

Provide the foreign passport number and the country of issuance in the following format:

[Number], [Country]

Employee: Attestation

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.

Employee: Preparer or Translator Assistance

Did a preparer or translator assist you in completing this form?

Did a preparer or translator assist you in completing this form? NoYes, one person assisted meYes, two people assisted meYes, three people assisted meYes, four people assisted me

Note: You may update your answer if you are returning to this form.

If you did not receive the assistance of a translator or preparer when initially filling out this form, but are receiving assistance for reverification or rehiring, you can select the number of people assisting you.

Or, if you did receive assistance the first time, and are receiving assistance from a different person or persons for reverification or rehiriring, you can modify the selection.

First Preparer or Translator

Preparer or Translator 1: First Name

Preparer or Translator 1: Last Name

Preparer or Translator 1: Middle Initial

If none, leave blank

Preparer or Translator 1: Address (Street Number and Name)

Include apartment or unit number, if any

Preparer or Translator 1: City or Town

Preparer or Translator 1: State

Preparer or Translator 1: Zip Code

Preparer or Translator 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. Further, I understand that, once my portion of this form is complete, I must sign and date it.

Second Preparer or Translator

Preparer or Translator 2: First Name

Preparer or Translator 2: Last Name

Preparer or Translator 2: Middle Initial

If none, leave blank

Preparer or Translator 2 Street Number and Name

Include apartment or unit number if applicable

Preparer or Translator 2: City or Town

Preparer or Translator 2: State

Preparer or Translator 2: Zip Code

Preparer or Translator 2: 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. Further, I understand that, once my portion of this form is complete, I must sign and date it.

Third Preparer or Translator

Preparer or Translator 3: First Name

Preparer or Translator 3: Last Name

Preparer or Translator 3: Middle Initial

If none, leave blank

Preparer or Translator 3: Street Number and Name

Include apartment or unit number, if applicable

Preparer or Translator 3: City or Town

Preparer of Translator 3: State

Preparer or Translator 3: Zip Code

Preparer or Translator 3: 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. Further, I understand that, once my portion of this form is complete, I must sign and date it.

Fourth Preparer or Translator

Preparer or Translator 4: First Name

Preparer or Translator 4: Last Name

Preparer or Translator 4: Middle Initial

If none, leave blank

Preparer or Translator 4: Street Number and Name

Include apartment or unit number, if applicable

Preparer or Translator 4: City or Town

Preparer or Translator 4: State

Preparer or Translator 4: Zip Code

Preparer or Translator 4: 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. Further, I understand that, once my portion of this form is complete, I must sign and date it.

Please select one item.

Selection of Documents

Employers: You must examine an employee's required documents within 3 days of the employee's first day of work, unless the employee is working for a total of less than 3 days, in which case you must examine the documents no later than the employee's first day

Are you ready to begin the document review process, or will you do this at a later date?

Are you ready to begin the document review process, or will you do this at a later date? Begin the document review processComplete at a later date

How will the employee satisfy Form I-9's documents requirement?

How will the employee satisfy Form I-9's documents requirement? Documentation from List AA combination of documentation from List B and List C

A complete I-9 requires the employee to present documents demonstrating their identity and eligibility to work in the United States. Form I-9 contains three lists of documents that can satisfy these requirements. The choice of which document or documents to present belongs to the employee; employers may not require or refuse to accept categories of documents.

Employer: Review of List A Documents

List A Document Title

List A Document Issuing Authority

The agency responsible for issuing the document. Common abbreviations, such as "SSA" for Social Security Administration, are acceptable.

List A Document Number

If none, leave blank

List A Document Expiration Date

If none, leave blank

Does the employee's List A Documentation consist of multiple documents?

Does the employee's List A Documentation consist of multiple documents? NoYes, one additional documentYes, two additional documents

Some List A Documentation may consist of multiple documents, such as a foreign passport and an endorsed Form I-94

Second List A Document

Title of Second List A Document

Issuing Authority of Second List A Document

Number of Second List A Document

If none leave blank

Expiration Date of Second List A Document

If none, leave blank

Third List A Document

Title of Third List A Document

Issuing Authority of Third List A Document

Number of Third List A Document

If none, leave blank

Expiration Date of Third List A Document

If none, leave blank

List B Document

List B Document Title

List B Document Issuing Authority

The agency responsible for issuing the document. Common abbreviations, such as "SSA" for Social Security Administration, are acceptable.

List B Document Number

If none, leave blank

List B Document Expiration Date

If none, leave blank

List C Document

List C Document Title

List C Document Issuing Authority

List C Document Number

If none, leave blank

List C Document Expiration Date

If none, leave blank

Employer: Additional Document Information

Do you want to include additional employee document information (uncommon)?

Do you want to include additional employee document information (uncommon)? YesNo

Additional Information

This section is not required, but may be used by employers to note, among other things: automatic extensions of EADs; additional documentation presented by those on student or exchange visas; and replacement information for employees who previously presented receipts of documents.

In most cases, this section will be used by employers after the I-9 has already been completed by both parties. If an additional notation is made, employers should print the document again, then date and initial the change.

Employer: Attestation

I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears 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.

Did you use a DHS-authorized alternative procedure to examine the documents described above?

Did you use a DHS-authorized alternative procedure to examine the documents described above? YesNo

Employers who are enrolled in the e-Verify program may examine employee documents remotely, rather than in person

I understand that I must sign and date this document, and retain it for at least three years or at least one year after the employee's last day, whichever comes later

I understand that I must sign and date this document, and retain it for at least three years or at least one year after the employee's last day, whichever comes later I do

Date of Employee's First Day of Work

Reverification/Rehiring

Is this form being used for reverification or rehiring of an employee?

Is this form being used for reverification or rehiring of an employee? NoYes

If an employee is being hired for the first time, mark "No." However, an employee's original I-9 form can also be used when the employee is rehired within three years of the date that their Form I-9 was first completed. When required, employers may use this section of the form to reverify or rehire the employee who has already filled out the sections of this form marked for "Employees."
Reverification of an employee is required when either (1) the date that the employee indicated, in their portion of Form I-9, that their work authorization expired has lapsed, or (2) one or more of the required documents that the employee used from either List A or List C has expired. An employer may fill out this section, and include it with the previously filled-out document.
If the employee has changed their name in this time period, employers can write the new name in the name section. If the rehired employee's work authorization has lapsed, or one or more of their required documents has lapsed, then the employer must also reverify the employee as described in the previous paragraph.

How many times is this employee being rehired or reverified?

How many times is this employee being rehired or reverified? Select One123

Employers can use the same Form I-9 to rehire or reverify an employee multiple times within three years of the date on which the employee began work. If this is the first time the employee is being rehired or needs reverification, the employer should select "1." If, after this rehiring or reverification, the employee is rehired again, or needs subsequent reverification, the employer may return to this form and select "2" or, if necessary again, "3."

First Rehiring

Date of Rehiring

If the employee is only being reverified, leave blank

Employee First Name

Form I-9 can be used if the person being rehired has changed their name since last working for the employer. If the employee has not changed their name, write "Same" for this field and the next two

Employee Last Name

Employee Middle Initial

Does this employee need to be reverified as well?

Does this employee need to be reverified as well? YesNo

First Reverification

Document Title

The title of the document or documents that the employee is presenting to the employer to satisfy reverification

Document Number

If none, leave blank

Document Expiration Date

If none, leave blank

Name of Employer or Authorized Representative Reviewing Documents for Reverification

First Reverification: 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. Further, I understand that after completing this section, I must sign and date it.

Remote Verification

Remote Verification I verified these documents remotely

If you examined this document or documents in person, leave blank

Second Rehiring

Date of Second Rehiring

If employee is only being reverified, leave blank

Employee First Name

Form I-9 can be used if the person being rehired has changed their name since last working for the employer. If the employee has not changed their name, write "Same" for this field and the next two

Employee Last Name

Employee Middle Initial

Please enter some text.

Does this employee need a second reverification?

Does this employee need a second reverification? NoYes

Second Reverification

Document Title

The title of the document or documents that the employee is presenting to the employer to satisfy reverification

Document Number

If none, leave blank

Document Expiration Date

If none, leave blank

Name of Employer or Authorized Representative Reviewing Documents for Reverification

Second Reverification: 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. Further, I understand that after completing this section, I must sign and date it.

Remote Verification

Remote Verification I verified these documents remotely

If you examined this document or documents in person, leave blank

Third Rehiring

Date of Rehiring

If the employee is only being reverified, leave blank

Employee First Name

Form I-9 can be used if the person being rehired has changed their name since last working for the employer. If the employee has not changed their name, write "Same" for this field and the next two

Employee Last Name

Employee Middle Initial

Does this employee need a third reverification?

Does this employee need a third reverification? NoYes

Third Reverification

Document Title

The title of the document or documents that the employee is presenting to the employer to satisfy reverification

Document Number

If none, leave blank

Document Expiration Date

If none, leave blank

Name of Employer or Authorized Representative Reviewing Documents for Reverification

Third Reverification: 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. Further, I understand that after completing this section, I must sign and date it.

Remote Verfication

Remote Verfication I verified these documents remotely

If you examined the document or documents in person, leave blank

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