Employment Eligibility Employment Eligiblity Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 10/31/2022 ►START HERE: <p><strong>►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,</strong><br /><strong>during completion of this form. Employers are liable for errors in the completion of this form.</strong><br /><strong>ANTI-DISCRIMINATION NOTICE:</strong> It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an<br />employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the<br />documentation presented has a future expiration date may also constitute illegal discrimination.</p> Section 1. <strong>Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later</strong> <strong>than the first day of employment, but not before accepting a job offer.)</strong> Last Name (Family Name) * First Name (Given Name) * Middle Initial Other Last Name Used (if any) Address (Street Number and Name) * Apt. Number City or Town * State * Zip Code Date of Birth (mm/dd/yyyy) * U.S. Social Security Number * Employee's E-mail Address * Employee's Telephone Number <strong>I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in</strong> <strong>connection with the completion of this form.</strong> <strong>I attest, under penalty of perjury, that I am (check one of the following boxes):</strong> * 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): 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Date * <strong>Some aliens may write "N/A" in the expiration date field. (See instructions)</strong> <p><strong>Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:</strong><br /><strong>An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.</strong></p> 1. Alien Registration Number/USCIS Number: QR Code - Section 1 Do Not Write In This Space <strong>OR</strong> 2. Form I-94 Admission Number: <strong>OR</strong> 3. Foreign Passport Number: Country of Issuance: Signature of Employee Clear Today's Date (mm/dd/yyyy) <strong>Preparer and/or Translator Certification (check one):</strong> I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. <strong>(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)</strong> <strong>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</strong> <strong>knowledge the information is true and correct.</strong> Signature of Preparer or Translator Clear Today's Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or Town State ZIP Code If you are human, leave this field blank. Submit
