Form I-9 Employment Eligibility Verification

USCIS
Form I-9

Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0047
Expires xx/xx/xxxx

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 origin 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)

DRAFT
NOT FOR
PRODODUCTION
09/13/2022

Address (Street Number and Name)

Date of Birth (mm/dd/yyyy)

Apt. Number (if any)

U.S. Social Security Number

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.

City or Town

State

Employee's Email Address

ZIP Code

Employee's Telephone 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 USCIS or A-Number.)

4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)

If you check Item Number 4., enter one of these:
USCIS/A-Number

OR

Form I-94 Admission Number

Signature of Employee

OR

Foreign Passport Number and Country of Issuance

Today's Date (mm/dd/yyyy)

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.

Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three
business days after the employee's first day of employment, and must physically examine documentation from List A OR a combination of
documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.
List A

OR

List B

List C

AND

Document Title 1
Issuing Authority

Document Number (if any)
Expiration Date (if any)

Additional Information

Document Title 2 (if any)
Issuing Authority

Document Number (if any)
Expiration Date (if any)
Document Title 3 (if any)
Issuing Authority
Document Number (if any)
Expiration Date (if any)
Certification: 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.
Last Name, First Name and Title of Employer or Authorized Representative

Employer's Business or Organization Name

First Day of Employment
(mm/dd/yyyy):

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Employer's Business or Organization Address, City or Town, State, ZIP Code

For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.

Form I-9 Edition 10/21/19

Page 1 of 4

LISTS OF ACCEPTABLE DOCUMENTS
All documents containing an expiration date must be unexpired.
* Documents extended by the issuing authority are considered unexpired.
Employees may present one selection from List A or a
combination of one selection from List B and one selection from List C.
Examples of many of these documents appear in the Handbook for Employers (M-274).
LIST A

LIST B

Documents that Establish Both Identity
and Employment Authorization

OR

Documents that Establish Identity

LIST C
AND

Documents that Establish Employment
Authorization

DRAFT
NOT FOR
PRODODUCTION
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1. U.S. Passport or U.S. Passport Card

1. Driver's license or ID card issued by a State or
outlying possession of the United States
provided it contains a photograph or
information such as name, date of birth,
gender, height, eye color, and address

2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
3. Foreign passport that contains a
temporary I-551 stamp or temporary
I-551 printed notation on a machinereadable immigrant visa

2. ID card issued by federal, state or local
government agencies or entities, provided it
contains a photograph or information such as
name, date of birth, gender, height, eye color,
and address

4. Employment Authorization Document
that contains a photograph (Form I-766)

3. School ID card with a photograph

5. For an individual temporarily authorized
to work for a specific employer because
of his or her status or parole:

4. Voter's registration card

a. Foreign passport; and

5. U.S. Military card or draft record

b. Form I-94 or Form I-94A that has the
following:

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner Card

(1) The same name as the passport;
and

8. Native American tribal document

(2) An endorsement of the
individual's status or parole as
long as that period of
endorsement has not yet
expired and the proposed
employment is not in conflict
with any restrictions or
limitations identified on the form.

9. Driver's license issued by a Canadian
government authority

For persons under age 18 who are
unable to present a document
listed above:

10. School record or report card

6. Passport from the Federated States of
Micronesia (FSM) or the Republic of the
Marshall Islands (RMI) with Form I-94 or
Form I-94A indicating nonimmigrant
admission under the Compact of Free
Association Between the United States
and the FSM or RMI

11. Clinic, doctor, or hospital record

12. Day-care or nursery school record

1. A Social Security Account Number card,
unless the card includes one of the following
restrictions:
(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH
INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH
DHS AUTHORIZATION

2. Certification of report of birth issued by the
Department of State (Forms DS-1350,
FS-545, FS-240)
3. Original or certified copy of birth certificate
issued by a State, county, municipal
authority, or territory of the United States
bearing an official seal
4. Native American tribal document

5. U.S. Citizen ID Card (Form I-197)

6. Identification Card for Use of Resident
Citizen in the United States (Form I-179)
7. Employment authorization document
issued by the Department of Homeland
Security
For examples, see Section 6 and
Section 12 of the M-274 on
uscis.gov/i-9-central.

The Form I-766, Employment
Authorization Document, is a List A, Item
Number 4. document, not a List C
document.

Acceptable Receipts
May be presented in lieu of a document listed above for a temporary period.
For receipt validity dates, see the M-274.
●

Receipt for a replacement of a lost,
stolen, or damaged List A document.

●

Form I-94 issued to a lawful
permanent resident that contains an
I-551 stamp and a photograph of the
individual.

●

Form I-94 with “RE” notation or
refugee stamp issued to a refugee.

OR

Receipt for a replacement of a lost, stolen, or
damaged List B document.

Receipt for a replacement of a lost, stolen, or
damaged List C document.

*Refer to the Employment Authorization Extensions page on I-9 Central for more information.

Form I-9 Edition 10/21/19

Page 2 of 4

Supplement A,
Preparer and/or Translator Certification for Section 1

USCIS
Form I-9
Supplement A

Department of Homeland Security
U.S. Citizenship and Immigration Services
Last Name (Family Name) from Section 1.

First Name (Given Name) from Section 1.

OMB No. 1615-0047
Expires xx/xx/xxxx

Middle initial (if any) from Section 1.

Instructions: This supplement must be completed by any preparer and/or translator who assists 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 above. 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.

DRAFT
NOT FOR
PRODODUCTION
09/13/2022

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)

Middle Initial (if any)

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

Middle Initial (if any)

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

Middle Initial (if any)

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 Edition 10/21/19

Date (mm/dd/yyyy)
First Name (Given Name)

City or Town

Middle Initial (if any)

State

ZIP Code

Page 3 of 4

Supplement B,
Reverification and Rehire (formerly Section 3)

USCIS
Form I-9
Supplement B

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0047
Expires xx/xx/xxxx

Last Name (Family Name) from Section 1.

First Name (Given Name) from Section 1.

Middle initial (if any) from Section 1.

Instructions: This supplement replaces Section 3 on the previous version of Form I-9. Only use this page if your employee requires
reverification, is rehired within three years of the date the original Form I-9 was completed, or provides proof of a legal name change. Enter
the employee's name in the fields above. Use a new section for each reverification or rehire. Review the Form I-9 instructions before
completing this page. Keep this page as part of the employee's Form I-9 record. Additional guidance can be found in the
Handbook for Employers: Guidance for Completing Form I-9 (M-274).

DRAFT
NOT FOR
PRODODUCTION
09/13/2022

Date of Rehire (if applicable)

New Name (if applicable)

Last Name (Family Name)

Date (mm/dd/yyyy)

First Name (Given Name)

Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show
continued employment authorization. Enter the document information in the spaces below.
Document Title

Document Number (if any)

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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Date of Rehire (if applicable)

New Name (if applicable)

Last Name (Family Name)

Date (mm/dd/yyyy)

First Name (Given Name)

Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show
continued employment authorization. Enter the document information in the spaces below.
Document Title

Document Number (if any)

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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Date of Rehire (if applicable)

New Name (if applicable)

Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show
continued employment authorization. Enter the document information in the spaces below.
Document Title

Document Number (if any)

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 documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Additional Information (Initial and date each notation.)

Form I-9 Edition 10/21/19

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