Form I-9 Supplement,                                    USCIS 
                        Section 1 Preparer and/or Translator Certification                     Form I-9 
                                                                                               Supplement 
                                    Department of Homeland Security                            OMB No. 1615-0047 
                                    U.S. Citizenship and Immigration Services                  Expires 10/31/2022

                        Last Name (Family Name) First Name (Given Name)                                Middle Initial
Employee 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                                           Date (mm/dd/yyyy)

Last Name (Family Name)                         First Name (Given Name)

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)

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)

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)

Address (Street Number and Name)                City or Town                       State       ZIP Code

Form I-9 Supplement   10/21/2019                                                                       Page 1 of 1