Employment Eligibility Verification

  • 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. Employer Information and Attestation (Employees must complete and sign Section of Form 1-9 no later than the first day of employment but not before accepting a job offer)
Last Name (Family Name)
First Name (Given Name)
Middle Initial
Other Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
I am aware that federal law provides for imprisonment and/or fines for false statements or use of falsedocuments in connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):




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 1-9:
An Alien Registration Number/USCIS Number OR Form 1-94 Admission Number OR Foreign PassportNumber.

OR

OR

Signature of Employee Today's Date (mm/dd/yyyy)
Prepare and/or Translator Certification (Check one)

(Fields below must be completed and signed when preparer 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
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code