Form I-9 Employment Eligibility Verification

Guides new hires and employers through documenting identity and work authorization in the United States, from the employee attestation to the document review and rehire sections. There is room for preparers or translators who assist with completion.

Use this template

No image

Instructions: read before completing

Last name (family name)

Name

Nombre

Apellido

Address (street number and name)

Apt. number (if any)

City or town

State

ZIP code

Date of birth (mm/dd/yyyy)

Employee's email address

Employee's telephone number

Check one of the following boxes to attest to your citizenship or immigration status (see pages 2 and 3 of the instructions)

A citizen of the United States A noncitizen national of the United States A lawful permanent resident A noncitizen authorized to work

3. A lawful permanent resident: enter your USCIS or A-Number

1. A citizen of the United States

Applies Does not apply Not sure

4. A noncitizen (other than items 2 and 3 above) authorized to work until (expiration date, if any)

Section 1: Employee information and attestation

USCIS A-Number

Form I-94 admission number

Foreign passport number and country of issuance

Signature of employee

Today's date (mm/dd/yyyy)

Documentation for noncitizens

List A

List B

List C

Issuing authority

Document number (if any)

Expiration date (if any)

Document title 2 (if any)

Additional information

E-Verify case number Receipt presented DHS alternative procedure Other notation

Issuing authority

Document number (if any)

Expiration date (if any)

Document title 3 (if any)

Issuing authority

Document number (if any)

Expiration date (if any)

Check here if you used an alternative procedure authorized by DHS to examine documents

Section 2: Employer review and verification

First day of employment (mm/dd/yyyy)

Last name, first name and title of the employer or authorized representative

Signature of the employer or authorized representative

Today's date (mm/dd/yyyy)

Employer's business or organization name

Employer's business or organization address, city or town, state, ZIP code

Employer certification

Employer details

Supplement A: Preparer and/or translator

Supplement instructions

Preparer or translator attestation

Preparer or translator 1

No image

Preparer or translator 2

Preparer or translator 3

Name

Nombre

Apellido

Preparer or translator 4

Signature of the preparer or translator

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

State

ZIP code

Supplement B: Rehire and reverification

Signature of the preparer or translator

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

State

ZIP code

Rehired employee details

Signature of the preparer or translator

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

State

ZIP code

Rehire block 1

Signature of the preparer or translator

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Address

Dirección

Ciudad

Estado / Provincia

Código postal

State

ZIP code

No image

Rehire date

Name

Nombre

Apellido

Document reverification

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Employer certification (rehire)

Document title

Document number (if any)

Expiration date, if any (mm/dd/yyyy)

Rehire block 2

Name of the employer or authorized representative

Signature of the employer or authorized representative

Today's date (mm/dd/yyyy)

Additional information: initial and date each notation

E-Verify case number Receipt presented DHS alternative procedure Other notation

Rehire date

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Document reverification

Document title

Document number (if any)

Expiration date, if any (mm/dd/yyyy)

Employer certification (rehire)

Name of the employer or authorized representative

Signature of the employer or authorized representative

Today's date (mm/dd/yyyy)

Additional information: initial and date each notation

E-Verify case number Receipt presented DHS alternative procedure Other notation

Rehire block 3

Date (mm/dd/yyyy)

Name

Nombre

Apellido

Rehire date

Document title

Document number (if any)

Expiration date, if any (mm/dd/yyyy)

Document reverification

Name of the employer or authorized representative

Signature of the employer or authorized representative

Today's date (mm/dd/yyyy)

Additional information: initial and date each notation

E-Verify case number Receipt presented DHS alternative procedure Other notation

Related templates

Browse all verification templates →