Supplement for Section 1 Preparer or Translator Certification for I-9

Form I-9 Supplement,
Section 1 Preparer and/or Translator Certification
Department of Homeland Security
U.S. Citizenship and Immigration Services

Employee Name:

Last Name (Family Name)

USCIS
Form I-9
Supplement

OMB No. 1615-0047
Expires 03/31/2016

Middle Initial

First Name (Given Name)

Instructions: This supplement may be used if extra spaces are required to document more than one preparer and/or translator
assisting an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in
the spaces provided. 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.
Signature of Preparer or Translator
Last Name (Family Name)
Address (Street Number and Name)

Date (mm/dd/yyyy)
First Name (Given Name)
City or Town

State

ZIP Code

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.
Signature of Preparer or Translator
Last Name (Family Name)
Address (Street Number and Name)

Date (mm/dd/yyyy)
First Name (Given Name)
City or Town

State

ZIP Code

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.
Signature of Preparer or Translator
Last Name (Family Name)
Address (Street Number and Name)

Date (mm/dd/yyyy)
First Name (Given Name)
City or Town

State

ZIP Code

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.
Signature of Preparer or Translator
Last Name (Family Name)
Address (Street Number and Name)

Form I-9 Supplement XX/XX/XXXX

Date (mm/dd/yyyy)
First Name (Given Name)
City or Town

DRAFT - NOT FOR PRODUCTION

State

ZIP Code

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