17

Form I-9 Presentation

Embed Size (px)

DESCRIPTION

Presentation explaining the rationale and process behind the redesign of the Employment Eligibility Verification form and accompanying document list.

Citation preview

Page 1: Form I-9 Presentation
Page 2: Form I-9 Presentation

FORM I-9REDESIGNED OCTOBER 2009

Page 3: Form I-9 Presentation

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.

Page 4: Form I-9 Presentation

ThE CuRRENT fORm I-9

Page 5: Form I-9 Presentation

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

Page 6: Form I-9 Presentation

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

Page 7: Form I-9 Presentation

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?

Page 8: Form I-9 Presentation

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

Page 9: Form I-9 Presentation

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

Page 10: Form I-9 Presentation

LINGuISTIC CLARITYEditing unnessarily confusing language

Considering potentially foreign audience

LEGAL mATTERSResearching the form verification process

Understanding common mistakes

REfINING ThE CONTENT

Page 11: Form I-9 Presentation

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

Page 12: Form I-9 Presentation

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

Page 13: Form I-9 Presentation

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

Page 14: Form I-9 Presentation

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

Page 15: Form I-9 Presentation

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

Page 16: Form I-9 Presentation

ThANK YOu.Sharon [email protected]

Page 17: Form I-9 Presentation