U.S. Department of Justice
OMB No. 1115-0136
Immigration and Naturalization Service
Employment Eligibility Verification
INSTRUCTIONS
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM.
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 of a future expiration date may also constitute illegal discrimination.
Section 1 - Employee.
All employees, citizens and If an employee is rehired within three (3) years of the
noncitizens, hired after November 6, 1986, must complete date this form was originally completed and the
Section 1 of this form at the time of hire, which is the actual employee's work authorization has expired
or
if a
beginning of employment.
The employer is responsible for
current employee's work authorization is about to
ensuring that Section 1 is timely and properly completed.
expire (reverification), complete Block B and:
-
examine any document that reflects that the
employee is authorized to work in the U.S. (see
Preparer/Translator Certification.
The Preparer/Translator
List A
or
C
),
Certification must be completed if Section 1 is prepared by a
record the document title, document number
person other than the employee. A preparer/translator may be
-
and expiration date (if any) in Block C, and
used only when the employee is unable to complete Section 1
complete the signature block.
on his/her own. However, the employee must still sign Section
-
1.
Photocopying and Retaining Form I-9.
A blank I-9 may be
reproduced, provided both sides are copied. The Instructions
Section 2 - Em
p
lo
y
er.
For the purpose of completing this
must be available to all employees completing this form.
form, the term "employer" includes those recruiters and
Employers must retain completed I-9s for three (3) years after
referrers for a fee who are agricultural associations, agricultural
the date of hire or one (1) year after the date employment ends,
employers or farm labor contractors.
whichever is later.
For more detailed information, you may refer to the INS
Handbook for Employers, (Form M-274). You may obtain
Employers must complete Section 2 by examining evidence of
the handbook at your local INS office.
identity and employment eligibility within three (3) business
days of the date employment begins. If employees are
Privacy Act Notice.
The authority for collecting this
authorized to work, but are unable to present the required
information is the Immigration Reform and Control Act of
document(s) within three business days, they must present a
1986, Pub. L. 99-603 (8 USC 1324a).
receipt for the application of the document(s) within three
This information is for employers to verify the eligibility of
business days and the actual document(s) within ninety (90)
individuals for employment to preclude the unlawful hiring, or
days. However, if employers hire individuals for a duration of
recruiting or referring for a fee, of aliens who are not
less than three business days, Section 2 must be completed at
authorized to work in the United States.
the time employment begins.
Employers must record: 1)
document title;
2)
issuing authority;
3)
document number,
4)
This information will be used by employers as a record of their
expiration date, if any; and
5)
the date employment begins.
basis for determining eligibility of an employee to work in the
Employers must sign and date the certification. Employees
United States. The form will be kept by the employer and made
must present original documents. Employers may, but are not
available for inspection by officials of the U.S. Immigration and
required to, photocopy the document(s) presented. These
Naturalization Service, the Department of Labor and the Office
photocopies may only be used for the verification process and
of Special Counsel for Immigration Related Unfair Employment
must be retained with the I-9.
However, employers are still
Practices.
responsible for completing the I-9.
Submission of the information required in this form is voluntary.
However, an individual may not begin employment unless this
Section 3 - Updating and Reverification.
Employers
form is completed, since employers are subject to civil or
criminal penalties if they do not comply with the Immigration
must complete Section 3 when updating and/or reverifying the
Reform and Control Act of 1986.
I-9. Employers must reverify employment eligibility of their
employees on or before the expiration date recorded in
Reporting Burden.
We try to create forms and instructions that
Section 1. Employers
CANNOT
specify which document(s)
are accurate, can be easily understood and which impose the
they will accept from an employee.
least possible burden on you to provide us with information.
Often this is difficult because some immigration laws are very
If an employee's name has changed at the time this
complex. Accordingly, the reporting burden for this collection
form is being updated/ reverified, complete Block A.
of information is computed as follows:
1)
learning about this
form, 5 minutes;
2)
completing the form, 5 minutes; and
3)
If an employee is rehired within three (3) years of the
assembling and filing (recordkeeping) the form, 5 minutes, for
date this form was originally completed and the
an average of 15 minutes per response. If you have comments
employee is still eligible to be employed on the same
regarding the accuracy of this burden estimate, or suggestions
basis as previously indicated on this form (updating),
for making this form simpler, you can write to the Immigration
complete Block B and the signature block.
and Naturalization Service, HQPDI, 425 I Street, N.W., Room
4034, Washington, DC 20536. OMB No. 1115-0136.
EMPLOYERS MUST RETAIN COMPLETED FORM I-9
Form I-9 (Rev. 11-21-91)N
PLEASE DO NOT MAIL COMPLETED FORM I-9 TO INS
U.S. Department of Justice
OMB No. 1115-0136
Immigration and Naturalization Service
Employment Eligibility Verification
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 of 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 #
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.
A citizen or national of the United States
I attest, under penalty of per
j
ury, that I am (check one of the followin
g
):
A Lawful Permanent Resident (Alien # A
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 NamePreparer'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)
List A OR
List B
AND
List C
Document title:
Issuing authority:
Document #:
Expiration Date
(if any):
/ / / / / /
Document #:
Expiration Date
(if any):
/ /
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
(month/day/year)
and that to the best of my knowledge the employee
is eligible to work in the United States. (State employment agencies may omit the date the employee began
employment.)
/ /
Print Name
Title
Signature of Employer or Authorized Representative
Address
(Street Name and Number, City, State, Zip Code)
Date
(month/day/year)
Business or Organization Name
Section 3. Updating and Reverification
.
To be completed and signed by employer.
A. New Name
(if applicable)
B. Date of rehire
(month/day/year) (if applicable)
Expiration Date (if any):
/
C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment
eligibility.
Document #:
Document Title:
/
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. 11-21-91)N Page 2
LISTS OF ACCEPTABLE DOCUMENTS
LIST A
LIST B
LIST C
Documents that Establish Both
Documents that Establish Documents that Establish
Identity and Employment
OR
Identity
AND
Employment Eligibility
Eligibility
1.
Driver's license or ID card
1.
U.S. social security card issued
1.
U.S. Passport (unexpired or
issued by a state or outlying
by the Social Security
expired)
possession of the United States
Administration (other than a
provided it contains a
card stating it is not valid for
photograph or information such
employment)
(INS Form N-560 or N-561)
2.
Certificate of U.S. Citizenship
as name, date of birth, sex,
height, eye color and address
2.
Certification of Birth Abroad
3.
Certificate of Naturalization
2.
ID card issued by federal, state
issued by the Department of
(INS Form N-550 or N-570)
or local government agencies or
State (Form FS-545 or Form
entities, provided it contains a
DS-1350)
photograph or information such
4.
Unexpired foreign passport,
as name, date of birth, sex,
with I-551 stamp or attached
height, eye color and address
INS Form I-94 indicating
3.
Original or certified copy of a
unexpired employment
3.
School ID card with a
birth certificate issued by a
authorization
photograph
state, county, municipal
authority or outlying
5.
Alien Registration Receipt Card
4.
Voter's registration card
possession of the United
with photograph (INS Form States bearing an official seal
I-151 or I-551)
5.
U.S. Military card or draft record
6.
Military dependent's ID card
4.
Native American tribal document
6.
Unex
p
ired Tem
p
orar
y
Card (INS Form I-688)
7.
U.S. Coast Guard Merchant
Mariner Card
5.
U.S. Citizen ID Card (INS Form
7.
Unexpired Employment
Authorization Card (INS Form
8.
Native American tribal document
I-197)
I-688A)
9.
Driver's license issued by a
Canadian government authority
6.
ID Card for use of Resident
8.
Unexpired Reentry Permit (INS
Citizen in the United States
Form I-327)
For persons under age 18 who
(INS Form I-179)
are unable to present a
document listed above:
9.
Unexpired Refugee Travel
Document (INS Form I-571)
7.
Unexpired employment
10.
School record or report card
authorization document issued
10.
Unexpired Employment
by the INS (other then those
Authorization Document issued
11.
Clinic, doctor or hospital record
listed under List A)
by the INS which contains a
photograph (INS Form I-688B)
12.
Day-care or nursery school
record
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)
Form I-9 (Rev. 11-21-91)N Page 3