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                                            Employment Eligibility Verification                                                                     USCIS 
                                                                                                                                                    Form I-9
                                                     Department of Homeland Security                                                           OMB No.1615-0047 
                                                   U.S. Citizenship and Immigration Services                                                   Expires 07/31/2026 

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) 

Address (Street Number and Name)                        Apt. Number (if any)   City or Town                                     State          ZIP Code 
                                                                                                                                 
Date of Birth (mm/dd/yyyy)   U.S. Social Security Number      Employee's Email Address                                          Employee's Telephone Number 

I am aware that federal law              Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.): 
provides for imprisonment and/or            1.  A citizen of the United States 
fines for false statements, or the 
use of false documents, in                  2.  A noncitizen national of the United States (See Instructions.) 
connection with the completion of           3.  A lawful permanent resident (Enter USCIS or A-Number.) 
this form.  I attest, under penalty
of perjury, that this information,          4.  A noncitizen (other than Item Numbers 2. and  3.above) authorized to work until (exp. date, if any) 
including my selection of the box        If you check Item Number 4., enter one of these: 
attesting to my citizenship or
immigration status, is true and             USCIS A-Number               Form I-94 Admission Number            Foreign Passport Number and Country of Issuance 
                                                              OR                                       OR 
correct. 
Signature of Employee                                                                           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, or examine consistent with an alternative procedure 
authorized by the Secretary of DHS, 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                        AND                     List C 
Document Title 1 
Issuing Authority 
Document Number (if any) 
Expiration Date (if any) 
Document Title 2 (if any)                                     Additional Information 

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)                                                 Check here if you used an alternative procedure authorized by DHS to examine documents.         
Certification:  I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named     First Day of Employment 
employee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the          (mm/dd/yyyy): 
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 Signature of Employer or Authorized Representative           Today's Date (mm/dd/yyyy) 

Employer's Business or Organization Name                 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 0 /8 01/23                                                                                                                           Page 1 of 4

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

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

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

Form I-9 Edition 08/01/23 Page 2 of 4

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                                                 Supplement A,                                                       USCIS 
                             Preparer and/or Translator Certification for Section 1                                  Form I-9 
                                                                                                                 Supplement A
                                           Department of Homeland Security                                       OMB No. 1615-0047 
                                           U.S. Citizenship and Immigration Services                             Expires 07/31/2026 

Last Name (Family Name) from Section 1.          First Name (Given Name) from Section 1.        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. 

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                                                        Date (mm/dd/yyyy) 

Last Name (Family Name)                                  First Name (Given Name)                              Middle Initial (if any) 

Address (Street Number and 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                                                        Date (mm/dd/yyyy) 

Last Name (Family Name)                                  First Name (Given Name)                              Middle Initial (if any) 

Address (Street Number and 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                                                        Date (mm/dd/yyyy) 

Last Name (Family Name)                                  First Name (Given Name)                              Middle Initial (if any) 

Address (Street Number and 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                                                        Date (mm/dd/yyyy) 

Last Name (Family Name)                                  First Name (Given Name)                              Middle Initial (if any) 

Address (Street Number and Name)                                City or Town                         State       ZIP Code 
                                                                                                      
Form I-9  Edition 0 /8 01/23                                                                                                 Page 3 of 4

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                                                          Supplement B,                                                   USCIS 
                                                                                                                          Form I-9
                                 Reverification and Rehire (formerly Section 3) 
                                                                                                                          Supplement B
                                                        Department of Homeland Security                               OMB No. 1615-0047 
                                              U.S. Citizenship and Immigration Services                                   Expires 07/31/2026 

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) 
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.)                                                     Check here if you used an 
                                                                                                             alternative procedure authorized 
                                                                                                             by DHS to examine documents.         
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.)                                                     Check here if you used an 
                                                                                                             alternative procedure authorized 
                                                                                                             by DHS to examine documents.         
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.) 
                                                                                                             Check here if you used an 
                                                                                                             alternative procedure authorized 
                                                                                                             by DHS to examine documents.         

Form I-9  Edition 0 /8 01/23                                                                                                             Page 4 of 4

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