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Department of Homeland Security U.S. Citizenship and Immigration Services Form I-9, Employment Eligibility Verification Anti-Discrimination Notice. It is illegal to discriminate against any individual (other than an alien not authorized to work in the U.S.) in hiring, discharging, or recruiting or referring for a fee because of that individual's national origin or citizenship status. It is illegal to discriminate against work eligible individuals. Employers CANNOT specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents presented have a future expiration date may also constitute illegal discrimination. All employees, citizens and noncitizens, hired after November 6, 1986 and working in the United States must complete a Form I-9. OMB No. 1615-0047; Expires 06/30/09 Preparer/Translator Certification. The Preparer/Translator Certification must be completed if Section 1 is prepared by a person other than the employee. A preparer/translator may be used only when the employee is unable to complete Section 1 on his/her own. However, the employee must still sign Section 1 personally. Form I-9 (Rev. 06/05/07) N Please read all instructions carefully before completing this form. Instructions When Should the Form I-9 Be Used? What Is the Purpose of This Form? The purpose of this form is to document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. Section 2, Employer: For the purpose of completing this form, the term "employer" means all employers including those recruiters and referrers for a fee who are agricultural associations, agricultural employers or farm labor contractors. Filling Out the Form I-9 document(s) within three business days, they must present a receipt for the application of the document(s) within three business days and the actual document(s) within ninety (90) days. However, if employers hire individuals for a duration of less than three business days, Section 2 must be completed at the time employment begins. Employers must record: Section 1, Employee: This part of the form must be completed at the time of hire, which is the actual beginning of employment. Providing the Social Security number is voluntary, except for employees hired by employers participating in the USCIS Electronic Employment Eligibility Verification Program (E-Verify). The employer is responsible for ensuring that Section 1 is timely and properly completed. 1. Document title; 2. Issuing authority; 3. Document number; 4. Expiration date, if any; and 5. The date employment begins. Employers must sign and date the certification. Employees must present original documents. Employers may, but are not required to, photocopy the document(s) presented. These photocopies may only be used for the verification process and must be retained with the Form I-9. However, employers are still responsible for completing and retaining the Form I-9. Employers must complete Section 2 by examining evidence of identity and employment eligibility within three (3) business days of the date employment begins. If employees are authorized to work, but are unable to present the required Section 3, Updating and Reverification: Employers must complete Section 3 when updating and/or reverifying the Form I-9. Employers must reverify employment eligibility of their employees on or before the expiration date recorded in Section 1. Employers CANNOT specify which document(s) they will accept from an employee. B. If an employee is rehired within three (3) years of the date this form was originally completed and the employee is still eligible to be employed on the same basis as previously indicated on this form (updating), complete Block B and the signature block. C. If an employee is rehired within three (3) years of the date this form was originally completed and the employee's work authorization has expired or if a current employee's work authorization is about to expire (reverification), complete Block B and: A. If an employee's name has changed at the time this form is being updated/reverified, complete Block A. 1. Examine any document that reflects that the employee is authorized to work in the U.S. (see List A or C); 2. Record the document title, document number and expiration date (if any) in Block C, and 3. Complete the signature block. EMPLOYERS MUST RETAIN COMPLETED FORM I-9 PLEASE DO NOT MAIL COMPLETED FORM I-9 TO ICE OR USCIS Form I-9 (Rev. 06/05/07) N Page 2 To order USCIS forms, call our toll-free number at 1-800-870- 3676. Individuals can also get USCIS forms and information on immigration laws, regulations and procedures by telephoning our National Customer Service Center at 1-800- 375-5283 or visiting our internet website at www.uscis.gov. USCIS Forms and Information What Is the Filing Fee? There is no associated filing fee for completing the Form I-9. This form is not filed with USCIS or any government agency. The Form I-9 must be retained by the employer and made available for inspection by U.S. Government officials as specified in the Privacy Act Notice below. The authority for collecting this information is the Immigration Reform and Control Act of 1986, Pub. L. 99-603 (8 USC 1324a). Privacy Act Notice This information is for employers to verify the eligibility of individuals for employment to preclude the unlawful hiring, or recruiting or referring for a fee, of aliens who are not authorized to work in the United States. This information will be used by employers as a record of their basis for determining eligibility of an employee to work in the United States. The form will be kept by the employer and made available for inspection by officials of U.S. Immigration and Customs Enforcement, Department of Labor and Office of Special Counsel for Immigration Related Unfair Employment Practices. Submission of the information required in this form is voluntary. However, an individual may not begin employment unless this form is completed, since employers are subject to civil or criminal penalties if they do not comply with the Immigration Reform and Control Act of 1986. We try to create forms and instructions that are accurate, can be easily understood and which impose the least possible burden on you to provide us with information. Often this is difficult because some immigration laws are very complex. Accordingly, the reporting burden for this collection of information is computed as follows: 1) learning about this form, and completing the form, 9 minutes; 2) assembling and filing (recordkeeping) the form, 3 minutes, for an average of 12 minutes per response. If you have comments regarding the accuracy of this burden estimate, or suggestions for making this form simpler, you can write to: U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue, N.W., 3rd Floor, Suite 3008, Washington, DC 20529. OMB No. 1615-0047. Paperwork Reduction Act A blank Form I-9 may be reproduced, provided both sides are copied. The Instructions must be available to all employees completing this form. Employers must retain completed Forms I-9 for three (3) years after the date of hire or one (1) year after the date employment ends, whichever is later. Photocopying and Retaining the Form I-9 The Form I-9 may be signed and retained electronically, as authorized in Department of Homeland Security regulations at 8 CFR 274a.2. § Department of Homeland Security U.S. Citizenship and Immigration Services Form I-9, Employment Eligibility Verification OMB No. 1615-0047; Expires 06/30/09 Please read instructions carefully before completing this form. The instructions must be available during completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work eligible 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. Section 1. Employee Information and Verification. To be completed and signed by employee at the time employment begins. Print Name: Last First Middle Initial Maiden Name Address (Street Name and Number) Apt. # Date of Birth (month/day/year) State City Zip Code Social Security # A lawful permanent resident (Alien #) A A citizen or national of the United States 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. An alien authorized to work until (Alien # or Admission #) Employee's Signature Date (month/day/year) 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. Address (Street Name and Number, City, State, Zip Code) Print Name Preparer's/Translator's Signature Date (month/day/year) Section 2. Employer Review and Verification. To be completed and signed by employer. Examine one document from List A OR examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number and expiration date, if any, of the document(s). AND List B List C OR List A Document title: Issuing authority: Document #: Expiration Date (if any): Document #: Expiration Date (if any): and that to the best of my knowledge the employee is eligible to work in the United States. (State (month/day/year) employment agencies may omit the date the employee began employment.) CERTIFICATION - I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on Print Name Title Signature of Employer or Authorized Representative Date (month/day/year) Business or Organization Name and Address (Street Name and Number, City, State, Zip Code) B. Date of Rehire (month/day/year) (if applicable) A. New Name (if applicable) C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment eligibility. Document #: Expiration Date (if any): Document Title: Section 3. Updating and Reverification. To be completed and signed by employer. l attest, under penalty of perjury, that to the best of my knowledge, this employee is eligible 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. Date (month/day/year) Signature of Employer or Authorized Representative Form I-9 (Rev. 06/05/07) N I attest, under penalty of perjury, that I am (check one of the following): For persons under age 18 who are unable to present a document listed above: LISTS OF ACCEPTABLE DOCUMENTS LIST A LIST B LIST C 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551) 7. Unexpired employment authorization document issued by DHS (other than those listed under List A) 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 1. U.S. Social Security card issued by the Social Security Administration (other than a card stating it is not valid for employment) 9. Driver's license issued by a Canadian government authority 1. U.S. Passport (unexpired or expired) 2. Certification of Birth Abroad issued by the Department of State (Form FS-545 or Form DS-1350) 3. An unexpired foreign passport with a temporary I-551 stamp 4. An unexpired Employment Authorization Document that contains a photograph (Form I-766, I-688, I-688A, I-688B) 3. Original or certified copy of a birth certificate issued by a state, county, municipal authority or outlying possession of the United States bearing an official seal 3. School ID card with a photograph 5. An unexpired foreign passport with an unexpired Arrival-Departure Record, Form I-94, bearing the same name as the passport and containing an endorsement of the alien's nonimmigrant status, if that status authorizes the alien to work for the employer 6. Military dependent's ID card 4. Native American tribal document 7. U.S. Coast Guard Merchant Mariner Card 5. U.S. Citizen ID Card (Form I-197) 8. Native American tribal document 6. ID Card for use of Resident Citizen in the United States (Form I-179) 10. School record or report card 11. Clinic, doctor or hospital record 12. Day-care or nursery school record Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274) 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 Form I-9 (Rev. 06/05/07) N Page 2 4. Voter's registration card 5. U.S. Military card or draft record Documents that Establish Both Identity and Employment Eligibility Documents that Establish Identity Documents that Establish Employment Eligibility OR AND