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Employment Handbook Form
Employment Handbook Form
Employment Handbook
Step 1 of 3
33%
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE:
It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name)
*
First Name (Given Name)
*
Other Last Names Used
(if any)
Address
*
(Street Number and Name)
Apt. Number
*
City or Town
*
State
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
(mm/dd/yyyy)
U.S. SSN
*
000-00-0000
Emp. E-mail Adress
*
Emp. Phone Number
*
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. I attest, under penalty of perjury, that I am (check one of the following boxes):
citizen
1. A citizen of the United States
noncitizen
2. A noncitizen national of the United States (See instructions)
resident
3. A lawful permanent resident
(Alien Registration Number/USCIS Number):
an alien
4. An alien authorized to work
until (expiration date, if applicable, mm/dd/yyyy)
Some aliens may write "N/A" in the expiration date field. (See instructions)
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1. Alien Registration Number/USCIS Number:
OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:
Country of Issuance:
Signature of Employee
*
Today's Date
*
Date Format: MM slash DD slash YYYY
(mm/dd/yyyy)
Today's Date
*
Date Format: MM slash DD slash YYYY
(mm/dd/yyyy)
Preparer and/or Translator Certification (check one):
I did not use a preparer or translator
I did not use a preparer or translator
A preparer(s) and/or translator(s) assisted
A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator
Last Name (Family Name)
First Name (Given Name)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")
Employee Info from Section 1
Last Name (Family Name)
*
First Name (Given Name)
Citizenship
Immigration Status
List A
Identity and Employment Authorization
Document Title
*
Issuing Authority
*
Document Number
*
Expiration Date
(if any) (mm/dd/yyyy)
Document Title
*
Issuing Authority
*
Document Number
*
Expiration Date
(if any) (mm/dd/yyyy)
OR
List B Identity
Document Title
*
Issuing Authority
*
Document Number
*
Expiration Date
(if any) (mm/dd/yyyy)
AND
List C
Employment Authorization
Document Title
*
Issuing Authority
*
Document Number
*
Expiration Date
(if any) (mm/dd/yyyy)
Additional Information
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy):
Date
Date Format: MM slash DD slash YYYY
(See instructions for exemptions)
Signature of Employer or Authorized Representative
*
Today's Date
Date Format: MM slash DD slash YYYY
Title of Employer or Authorized Representative
Last Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable)
B. Date of Rehire (if applicable)
Last Name (Family Name)
First Name (Given Name)
Middle Initial
Date (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
Document Title
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative
*
Today's Date
Date Format: MM slash DD slash YYYY
Title of Employer or Authorized Representative
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List Aor a combination of one selection from List B and one selection from List C
LIST A
Documents that Establish Both Identity and Employment Authorization
1. U.S. Passport or U.S. Passport Card
2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine readable immigrant visa
4. Employment Authorization Document that contains a photograph (Form I-766)
5. For a non immigrant alien authorized to work for a specific employer because of his or her status:
a. Foreign passport; and
b. Form I-94 or Form I-94A that has the following:
(1) The same name as the passport; and
(2) An endorsement of the alien's non immigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.
6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI
LIST B
Documents that Establish Identity
1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
3. School ID card with a photograph
4. Voter's registration card
5. U.S. Military card or draft record
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner Card
8. Native American tribal document
9. Driver's license issued by a Canadian government authority
For persons under age 18 who are unable to present a document listed above:
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record
LIST C
Documents that Establish Employment Authorization
1.A Social Security Account Number card, unless the card includes one of the following restrictions:
(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION
2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)
3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal
4. Native American tribal document
5. U.S. Citizen ID Card (Form I-197)
6. Identification Card for Use of Resident Citizen in the United States (Form I-179)
7. Employment authorization document issued by the Department of Homeland Security
Examples of many of these documents appear in the Handbook for Employers (M-274).
Refer to the instructions for more information about acceptable receipts
