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Presentation explaining the rationale and process behind the redesign of the Employment Eligibility Verification form and accompanying document list.
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FORM I-9REDESIGNED OCTOBER 2009
FORM I-9 is the Employee Eligibility Verification Form issued by U.S. Citizenship and Immigration Services. It is used by employers to verify an employee’s identity and establish that the worker is eligible to work in the U.S.
It is terribly designed.
ThE CuRRENT fORm I-9
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
ThE NEw fORm I-9
1. ASSESS CuRRENT POSITION.Define the uses of the form, its audience, and effectiveness.
2. DEfINE ChALLENGES.Identify problem areas and ambiguities.
3. REfINE CONTENT.Refine language, grouping, and hierarchy.
4. REDESIGN. Recreate and make adjustments in Illustrator.
5. REfINE.Assess redesign & make edits.
ThE REDESIGN PROCESS
ASSESSING ThE CuRRENT fORm
AS A uSERWhat do I fill out?
What does my employer fill out?
Where do I sign?
Where does it say what day I get hired?
How many documents do I need?
Is it better to use one document over another?
AS A uSERWhat do I fill out?
What does my employer fill out?
Where do I sign?
Where does it say what day I get hired?
How many documents do I need?
Is it better to use one document over another?
AS A DESIGNERHow can the grouping/typographic hierarchy be clarified?
Can I eliminate some of the extraneous lines and language?
How can the form become more open and user-friendly?
How can the form get more consistent?
ASSESSING ThE CuRRENT fORm
GROuPINGTypes of information
Who fills out what
{(A or B) & C} vS {A or (B & C)}
hIERARChY1. Form title/header
2. Section titles/instructions
3. Document information
4. Identifying information
5. Signature indications
6. Government numbers/footer
DEfINING ThE ChALLENGES
LINGuISTIC CLARITYEditing unnessarily confusing language
Considering potentially foreign audience
LEGAL mATTERSResearching the form verification process
Understanding common mistakes
REfINING ThE CONTENT
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
Form I-9 (Rev. 08/07/09) Y Page 4
Section 3. Updating & Reverification (To be completed and signed by employer.)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 document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
LIST C
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST B
Street No. & Name, City, State, Zip Code
EXAMINE ONE DOCUMENT FROM
List A OR B & C as listed on the reverse of this form. Record all listed informationfor each of the document(s) withoutabbreviations. Pay special attention toissuing authority and expiration dates, where applicable.
ORA B C+ }{I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
and that to the best of my knowledge theemployee is authorized to work in the U.S.
HIRE DATE
LIST A
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
Last, First Middle (Maiden if applicable)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Street No. & Name, Apartment No.
Street No. & Name, City, State, Zip Code
City, State, Zip Code
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to work
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident
NEW NAME (IF APPLICABLE) DATE OF REHIRE (IF APPLICABLE)
DOCUMENT TITLE DOCUMENT NO.
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE DATE
EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITYDATE
EMPLOYER’S NAME, TITLE
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE
BUSINESS/ORGANIZATION NAME
ADDRESS
DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
EMPLOYEE SIGNATURE
EMPLOYEE NAME
ADDRESS
SOCIAL SECURITY NO. DATE OF BIRTH
ADDRESS
DATE
PREPARER/TRANSLATOR SIGNATURE DATE
PREPARER/TRANSLATOR NAME DATEALIEN NO.
ALIEN NO./ADMISSION NO. EXP. DATE
REDESIGNING & REfINING
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 LIST OF ACCEPTABLE DOCUMENTSALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Emploers (M-274) Part 8.
To be eligible for employment, employee must provide either one document from list A, or one document each from list B and C.
Form I-9 (Rev. 08/07/09) Y Page 5
ORA B C+ }{LIST ADOCUMENTS THAT ESTABLISH BOTH IDENTITY ANDEMPLOYMENT AUTHORIZATION
LIST B DOCUMENTS THAT ONLY ESTABLISH IDENTITY
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
LIST C DOCUMENTS THAT ESTABLISH EMPLOYMENTAUTHORIZATION
Employment Authorization Formthat contains a photographI-766
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer. Contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions.
I-94AI-94
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission.
I-94AI-94
U.S. Passport or U.S. Passport Card Driver’s license or state-issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
I-197
FS-545
I-179
DS-1350
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
I-551Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
I-551
REDESIGNING & REfINING
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
Form I-9 (Rev. 08/07/09) Y Page 4
Section 3. Updating & Reverification (To be completed and signed by employer.)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 document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
LIST C
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST B
Street No. & Name, City, State, Zip Code
EXAMINE ONE DOCUMENT FROM
List A OR B & C as listed on the reverse of this form. Record all listed informationfor each of the document(s) withoutabbreviations. Pay special attention toissuing authority and expiration dates, where applicable.
ORA B C+ }{I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
and that to the best of my knowledge theemployee is authorized to work in the U.S.
HIRE DATE
LIST A
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
Last, First Middle (Maiden if applicable)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Street No. & Name, Apartment No.
Street No. & Name, City, State, Zip Code
City, State, Zip Code
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to work
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident
NEW NAME (IF APPLICABLE) DATE OF REHIRE (IF APPLICABLE)
DOCUMENT TITLE DOCUMENT NO.
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE DATE
EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITYDATE
EMPLOYER’S NAME, TITLE
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE
BUSINESS/ORGANIZATION NAME
ADDRESS
DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
EMPLOYEE SIGNATURE
EMPLOYEE NAME
ADDRESS
SOCIAL SECURITY NO. DATE OF BIRTH
ADDRESS
DATE
PREPARER/TRANSLATOR SIGNATURE DATE
PREPARER/TRANSLATOR NAME DATEALIEN NO.
ALIEN NO./ADMISSION NO. EXP. DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 LIST OF ACCEPTABLE DOCUMENTSALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Emploers (M-274) Part 8.
To be eligible for employment, employee must provide either one document from list A, or one document each from list B and C.
Form I-9 (Rev. 08/07/09) Y Page 5
ORA B C+ }{LIST ADOCUMENTS THAT ESTABLISH BOTH IDENTITY ANDEMPLOYMENT AUTHORIZATION
LIST B DOCUMENTS THAT ONLY ESTABLISH IDENTITY
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
LIST C DOCUMENTS THAT ESTABLISH EMPLOYMENTAUTHORIZATION
Employment Authorization Formthat contains a photographI-766
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer. Contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions.
I-94AI-94
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission.
I-94AI-94
U.S. Passport or U.S. Passport Card Driver’s license or state-issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
I-197
FS-545
I-179
DS-1350
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
I-551Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
I-551
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
REDESIGNING & REfINING
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
Form I-9 (Rev. 08/07/09) Y Page 4
Section 3. Updating & Reverification (To be completed and signed by employer.)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 document(s), the document(s) l have examined appear to be genuine and to relate to the individual.
LIST C
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST B
Street No. & Name, City, State, Zip Code
EXAMINE ONE DOCUMENT FROM
List A OR B & C as listed on the reverse of this form. Record all listed informationfor each of the document(s) withoutabbreviations. Pay special attention toissuing authority and expiration dates, where applicable.
ORA B C+ }{I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
and that to the best of my knowledge theemployee is authorized to work in the U.S.
HIRE DATE
LIST A
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
Last, First Middle (Maiden if applicable)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Street No. & Name, Apartment No.
Street No. & Name, City, State, Zip Code
City, State, Zip Code
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to work
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident
NEW NAME (IF APPLICABLE) DATE OF REHIRE (IF APPLICABLE)
DOCUMENT TITLE DOCUMENT NO.
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE DATE
EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITYDATE
EMPLOYER’S NAME, TITLE
EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE
BUSINESS/ORGANIZATION NAME
ADDRESS
DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT NO. EXP. DATE
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. EXP. DATE
EMPLOYEE SIGNATURE
EMPLOYEE NAME
ADDRESS
SOCIAL SECURITY NO. DATE OF BIRTH
ADDRESS
DATE
PREPARER/TRANSLATOR SIGNATURE DATE
PREPARER/TRANSLATOR NAME DATEALIEN NO.
ALIEN NO./ADMISSION NO. EXP. DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES OMB No. 1615-0047; Expires 08/31/12
FORM I-9 LIST OF ACCEPTABLE DOCUMENTSALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Emploers (M-274) Part 8.
To be eligible for employment, employee must provide either one document from list A, or one document each from list B and C.
Form I-9 (Rev. 08/07/09) Y Page 5
ORA B C+ }{LIST ADOCUMENTS THAT ESTABLISH BOTH IDENTITY ANDEMPLOYMENT AUTHORIZATION
LIST B DOCUMENTS THAT ONLY ESTABLISH IDENTITY
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
LIST C DOCUMENTS THAT ESTABLISH EMPLOYMENTAUTHORIZATION
Employment Authorization Formthat contains a photographI-766
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer. Contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions.
I-94AI-94
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission.
I-94AI-94
U.S. Passport or U.S. Passport Card Driver’s license or state-issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID cardprovided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
I-197
FS-545
I-179
DS-1350
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
I-551Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
I-551
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers cannot specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a future expiration date may also constitute illegal discrimination.
OMB No. 1615-0047 Form I-9 Y Page 4 *Fill out only if applicable
Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)
CHECK ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am:
An alien authorized to workuntil a certain date
A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent residentof the United States
EMPLOYEE NAME (Last, First Middle, Maiden*)
ADDRESS (Street No. & Name, Apartment No.)
(City, State, Zip Code)
SOCIAL SECURITY NO. (xxx-xx-xxxx) DATE OF BIRTH (mm/dd/yyyy)
ALIEN NO.
EXP. DATEALIEN NO./ADMISSION NO.
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Preparer and/or Translator Certification*(To be completed and signed if Section 1 is prepared by a person other than the employee.)I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true.
PREPARER/TRANSLATOR NAME
ADDRESS
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
NEW NAME*
Section 3. Updating & Reverification* (To be completed and signed by employer.)
DATE OF REHIRE*
EXP. DATEDOCUMENT TITLE DOCUMENT NO.
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 document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
Section 2. Employer Review & Verification (To be completed and signed by employer.)
LIST A
LIST C
EXAMINE ONE DOCUMENT FROM List A OR
List B & List C as listed on the reverse of this form. Record all informationfor each of the appropriate document(s)without abbreviations.
ORA B C+ }{ LIST B
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
ISSUING AUTHORITY
DOCUMENT TITLE
DOCUMENT NO.* DATE*
DOCUMENT TITLE
ISSUING AUTHORITY
DOCUMENT NO. DATE
DOCUMENT NO. DATE
EMPLOYER’S NAME/TITLE
BUSINESS/ORGANIZATION NAME
ADDRESS (Street No. & Name)
(City, State, Zip Code)
HIRE DATE
I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on
EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE DATE
ThE NEw fORm I-9
ORA B C+
LIST B DOCUMENTS THAT ESTABLISH ONLYIDENTITY
LIST C DOCUMENTS THAT ESTABLISH ONLYEMPLOYMENT AUTHORIZATION
FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE
School record or report card
Clinic, doctor, or hospital record
Day care or nursery school record
Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.
School ID card with a photograph
Voter’s Registration Card
U.S. Military Card or draft record
U.S. Military dependent’s ID card
U.S. Coast Guard Merchant Mariner Card
Native American tribal document
Canadian driver’s license
LIST ADOCUMENTS THAT ESTABLISH BOTHIDENTITY AND EMPLOYMENT AUTHORIZATION
U.S. Passport or U.S. Passport Card
Permanent Resident Card or Resident Alien Card
Foreign passport containing temporarystamp or printed notation on a machine-readable immigrant visa
Employment Authorization Formthat contains a photograph
Foreign passport with or bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions
Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with or indicating non-immigrant admission
To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.
Social Security Account Number cardexcluding one which specifies that the issuance of the card does not authorize employment in the U.S.
Certification of Birth Abroad issued by the Department of State
Certification of Report of Birthissued by the Department of State
Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S.
U.S. Citizen ID Card
Identification Card for use of Resident Citizen in the United States
Native American tribal document
Employment authorization document issued by the Department of Homeland Security
ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Employers Part 8.M-274
DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES
FORM I-9 LIST OF ACCEPTABLE DOCUMENTS
OMB No. 1615-0047 Form I-9 Y Page 4
I-551
I-766
I-94AI-94
I-94AI-94
I-551
I-197
FS-545
I-179
DS-1350
ThE NEw fORm I-9
ThANK YOu.Sharon [email protected]