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Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
OMB No. 1615-0047
Expires 10/31/2022

►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)

Middle Initial

Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number

City or Town

State

ZIP Code

Date of Birth (mm/dd/yyyy)

U.S. Social Security Number

Employee's E-mail Address

Employee's Telephone 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):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident

(Alien Registration Number/USCIS Number):

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.

QR Code - Section 1
Do Not Write In This Space

1. Alien Registration Number/USCIS Number:
OR

2. Form I-94 Admission Number:

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee

Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

I did not use a preparer or translator.

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

Form I-9 10/21/2019

Page 1 of 3

Employer Completes Next Page

Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services

USCIS
Form I-9
OMB No. 1615-0047
Expires 10/31/2022

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.")

Last Name (Family Name)

First Name (Given Name)

M.I. Citizenship/Immigration Status

Employee Info from Section 1

List A
Identity and Employment Authorization

List B
Identity

AND

List C

Employment Authorization

Document Title

Issuing Authority

Document Title

Issuing Authority

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Additional Information

QR Code - Sections 2 & 3
Do Not Write In This Space

Expiration Date (if any) (mm/dd/yyyy)

Document Title

Issuing Authority

Document Number

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

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):

(See instructions for exemptions)

Signature of Employer or Authorized Representative

Today's Date (mm/dd/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) City or Town

State

ZIP Code

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
B. Date of Rehire (if applicable)
A. New Name (if applicable)
Last Name (Family Name)
Date (mm/dd/yyyy)

First Name (Given Name)

Middle Initial

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)

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 (mm/dd/yyyy)

Name of Employer or Authorized Representative

Form I-9 10/21/2019

Page 2 of 3

LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED

Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.

LIST A

LIST B

LIST C

Documents that Establish
Both Identity and
Employment Authorization

Documents that Establish
Identity

Documents that Establish
Employment Authorization

AND

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 nonimmigrant 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. 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

Voter's registration card

U.S. Military card or draft record

6. Military dependent's ID card

7. U.S. Coast Guard Merchant Mariner

(1) The same name as the passport;

Card

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)

Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal

Native American tribal document

U.S. Citizen ID Card (Form I-197)

and

(2) An endorsement of the alien's

nonimmigrant 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

Native American tribal document

9. Driver's license issued by a Canadian

government authority

6. Identification Card for Use of
Resident Citizen in the United
States (Form I-179)

For persons under age 18 who are
unable to present a document
listed above:

7. Employment authorization
document issued by the
Department of Homeland Security

10. School record or report card

11.

Clinic, doctor, or hospital record

12. Day-care or nursery school record

Examples of many of these documents appear in the Handbook for Employers (M-274).

Refer to the instructions for more information about acceptable receipts.

Form I-9 10/21/2019

Page 3 of 3

Employment Eligibility Verification Department of Homeland Security

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Alabama state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from eforms.alacourt.gov (2023-03)
Page(s): 3
Fields(s): 75
Average fields per page: 25
Reading Level: Grade 9
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

page_last_name_family__1 was topmostSubform[0].Page1[0].Last_Name_Family_Name[0] (0.59 conf)
topmost_first_name_given__1 was topmostSubform[0].Page1[0].First_Name_Given_Name[0] (0.43 conf)
topmost_page_middle_initial__1 was topmostSubform[0].Page1[0].Middle_Initial[0] (0.40 conf)
topmost_page_last_names_used was topmostSubform[0].Page1[0].Other_Last_Names_Used_if_any[0] (0.38 conf)
address_street_number_name__1 was topmostSubform[0].Page1[0].Address_Street_Number_and_Name[0] (0.38 conf)
topmost_page_apt_number was topmostSubform[0].Page1[0].Apt_Number[0] (0.39 conf)
topmost_subform_page_city_town__1 was topmostSubform[0].Page1[0].City_or_Town[0] (0.40 conf)
topmost_subform_page_zi_p_code was topmostSubform[0].Page1[0].ZIP_Code[0] (0.41 conf)
topmost_page_date_birth was topmostSubform[0].Page1[0].Date_of_Birth_mmddyyyy[0] (0.43 conf)
topmost_social_number_first was topmostSubform[0].Page1[0].U\.S\._Social_Security_Number__First_3_Numbers_[0] (0.38 conf)
topmost_social_number_numbers was topmostSubform[0].Page1[0].U\.S\._Social_Security_Number__Next_2_numbers_[0] (0.34 conf)
topmost_social_number_last was topmostSubform[0].Page1[0].U\.S\._Social_Security_Number__Last_4_numbers_[0] (0.38 conf)
employees_email_address was topmostSubform[0].Page1[0].Employees_Email_Address[0] (0.42 conf)
topmost_subform_page_employees_telephone_number was topmostSubform[0].Page1[0].Employees_Telephone_Number[0] (0.47 conf)
topmost_citizen_united_states was topmostSubform[0].Page1[0]._1\._A_citizen_of_the_United_States[0] (0.42 conf)
topmost_subform_page_noncitizen_national_united_states_see_instructions was topmostSubform[0].Page1[0]._2\._A_noncitizen_national_of_the_United_States__See_instructions_[0] (0.43 conf)
lawful_permanent_number was topmostSubform[0].Page1[0]._3\._A_lawful_permanent_resident__Alien_Registration_Number_USCIS_Number__[0] (0.44 conf)
topmost_registration_number__1 was topmostSubform[0].Page1[0].Alien_Registration_NumberUSCIS_Number_1[0] (0.44 conf)
topmost_subform_page_alien_authorized_work_expiration_date_applicable_mmd_dd_yyyy was topmostSubform[0].Page1[0]._4\._An_alien_authorized_to_work_until__expiration_date__if_applicable__mmd_dd_yyyy__[0] (0.38 conf)
topmost_subform_page_expiration_date_applicable_mm_dd_yyyy was topmostSubform[0].Page1[0].expiration_date__if_applicable__mm_dd_yyyy[0] (0.33 conf)
topmost_registration_number__2 was topmostSubform[0].Page1[0]._1_Alien_Registration_NumberUSCIS_Number[0] (0.37 conf)
topmost_page_admission_number was topmostSubform[0].Page1[0]._2_Form_I94_Admission_Number[0] (0.39 conf)
foreign_passport_number was topmostSubform[0].Page1[0]._3_Foreign_Passport_Number[0] (0.39 conf)
topmost_subform_page_country_issuance was topmostSubform[0].Page1[0].Country_of_Issuance[0] (0.39 conf)
topmost_page_use was topmostSubform[0].Page1[0].I_did_not_use_a_preparer_or_translator[0] (0.39 conf)
page_employee_section was topmostSubform[0].Page1[0].A_preparer_s__and_or_translator_s__assisted_the_employee_in_completing_Section_1[0] (0.41 conf)
page_last_name_family__2 was topmostSubform[0].Page1[0].Last_Name_Family_Name_2[0] (0.41 conf)
topmost_first_name_given__2 was topmostSubform[0].Page1[0].First_Name_Given_Name_2[0] (0.41 conf)
address_street_number_name__2 was topmostSubform[0].Page1[0].Address_Street_Number_and_Name_2[0] (0.37 conf)
topmost_subform_page_city_town__2 was topmostSubform[0].Page1[0].City_or_Town_2[0] (0.37 conf)
topmost_subform_page_zip_code was topmostSubform[0].Page1[0].Zip_Code[0] (0.39 conf)
topmost_subform_page_state__1 was topmostSubform[0].Page1[0].State[0] (0.38 conf)
topmost_subform_page_state__2 was topmostSubform[0].Page1[0].State[1] (0.38 conf)
page_last_name_family__3 was topmostSubform[0].Page2[0].Last_Name_Family_Name_3[0] (0.41 conf)
topmost_first_name_given__3 was topmostSubform[0].Page2[0].First_Name_Given_Name_3[0] (0.41 conf)
topmost_subform_page was topmostSubform[0].Page2[0].MI[0] (0.43 conf)
citizenship_immigration_status was topmostSubform[0].Page2[0].CitizenshipImmigration_Status[0] (0.36 conf)
page_list_document_title__1 was topmostSubform[0].Page2[0].List_A_-_Document_Title_1[0] (0.44 conf)
topmost_page_list_document_title__1 was topmostSubform[0].Page2[0].List_B_-_Document_Title[0] (0.36 conf)
topmost_page_list_document_title__2 was topmostSubform[0].Page2[0].List_C_-_Document_Title[0] (0.36 conf)
topmost_subform_page_list_issuing_authority__1 was topmostSubform[0].Page2[0].List_A_-_Issuing_Authority_1[0] (0.33 conf)
topmost_list_issuing_authority__1 was topmostSubform[0].Page2[0].List_B_-_Issuing_Authority[0] (0.38 conf)
topmost_list_issuing_authority__2 was topmostSubform[0].Page2[0].List_C_-_Issuing_Authority[0] (0.38 conf)
topmost_page_list_document__1 was topmostSubform[0].Page2[0].List_A_-_Document_Number_1[0] (0.42 conf)
topmost_list_document_number__1 was topmostSubform[0].Page2[0].List_B_-_Document_Number[0] (0.36 conf)
topmost_list_document_number__2 was topmostSubform[0].Page2[0].List_C_-_Document_Number[0] (0.36 conf)
topmost_subform_page_list_expiration_date_mm_dd_yyyy__1 was topmostSubform[0].Page2[0].List_A_-_Expiration_Date__if_any___mm_dd_yyyy__1[0] (0.34 conf)
topmost_subform_page_list_b_expiration_date_mm_dd_yyyy was topmostSubform[0].Page2[0].List_B_-_Expiration_Date__if_any___mm_dd_yyyy_[0] (0.38 conf)
topmost_subform_page_list_c_expiration_date_mm_dd_yyyy was topmostSubform[0].Page2[0].List_C_-_Expiration_Date__if_any___mm_dd_yyyy_[0] (0.38 conf)
page_list_document_title__2 was topmostSubform[0].Page2[0].List_A_-_Document_Title_2[0] (0.44 conf)
topmost_subform_page_list_issuing_authority__2 was topmostSubform[0].Page2[0].List_A_-_Issuing_Authority_2[0] (0.33 conf)
topmost_page_list_document__2 was topmostSubform[0].Page2[0].List_A_-_Document_Number_2[0] (0.42 conf)
topmost_subform_page_list_expiration_date_mm_dd_yyyy__2 was topmostSubform[0].Page2[0].List_A_-_Expiration_Date__if_any___mm_dd_yyyy__2[0] (0.34 conf)
page_list_document_title__3 was topmostSubform[0].Page2[0].List_A_-_Document_Title_3[0] (0.44 conf)
topmost_subform_page_list_issuing_authority__3 was topmostSubform[0].Page2[0].List_A_-_Issuing_Authority_3[0] (0.33 conf)
topmost_page_list_document__3 was topmostSubform[0].Page2[0].List_A_-_Document_Number_3[0] (0.42 conf)
topmost_subform_page_list_expiration_date_mm_dd_yyyy__3 was topmostSubform[0].Page2[0].List_A_-_Expiration_Date__if_any___mm_dd_yyyy__3[0] (0.34 conf)
page_additional_information was topmostSubform[0].Page2[0].Additional_Information[0] (0.44 conf)
last_name_representative was topmostSubform[0].Page2[0].Last_Name_of_Employer_or_Authorized_Representative[0] (0.41 conf)
first_name_representative was topmostSubform[0].Page2[0].First_Name_of_Employer_or_Authorized_Representative[0] (0.41 conf)
employers_business_organization was topmostSubform[0].Page2[0].Employers_Business_or_Organization_Name[0] (0.44 conf)
business_organization_number was topmostSubform[0].Page2[0].Employers_Business_or_Organization_Address_Street_Number_and_Name[0] (0.41 conf)
city_business_organization was topmostSubform[0].Page2[0].City_or_Town_of_Employers_Business_or_Organization[0] (0.40 conf)
page_last_name_family__4 was topmostSubform[0].Page2[0].Last_Name_Family_Name_4[0] (0.41 conf)
topmost_first_name_given__4 was topmostSubform[0].Page2[0].First_Name_Given_Name_4[0] (0.41 conf)
topmost_page_middle_initial__2 was topmostSubform[0].Page2[0].Middle_Initial_2[0] (0.41 conf)
topmost_subform_page_date_mmddyyyy was topmostSubform[0].Page2[0].Date_mmddyyyy[0] (0.40 conf)
topmost_page_document_title was topmostSubform[0].Page2[0].Document_Title_4[0] (0.35 conf)
page_document_number was topmostSubform[0].Page2[0].Document_Number_6[0] (0.38 conf)
topmost_expiration_date was topmostSubform[0].Page2[0].Expiration_Date_if_any_mmddyyyy_6[0] (0.34 conf)
topmost_subform_page_zip_code_employers_business_organization was topmostSubform[0].Page2[0].Zip_Code_of_Employers_Business_or_Organization[0] (0.38 conf)
page_text_field_title was topmostSubform[0].Page2[0].textFieldEmployerTitle[0] (0.38 conf)
page_text_field_employer was topmostSubform[0].Page2[0].textFieldEmployerName[0] (0.38 conf)
topmost_subform_page_state__3 was topmostSubform[0].Page2[0].State[0] (0.38 conf)
topmost_subform_page_employee_first_day_employment_mm_dd_yyyy was topmostSubform[0].Page2[0].The_employee_s_first_day_of_employment__mm_dd_yyyy_[0] (0.37 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

topmost_page_middle_initial__1
topmost_page_apt_number
topmost_page_date_birth
topmost_registration_number__1
topmost_registration_number__2
topmost_page_admission_number
topmost_list_document_number__1
topmost_list_document_number__2
topmost_page_middle_initial__2

Suggested Screen 1:

topmost_social_number_first
topmost_social_number_numbers
topmost_social_number_last
topmost_citizen_united_states

Suggested Screen 2:

employees_email_address

Suggested Screen 3:

lawful_permanent_number

Suggested Screen 4:

page_last_name_family__1
page_last_name_family__2
page_last_name_family__3
page_last_name_family__4

Suggested Screen 5:

topmost_subform_page_city_town__1
topmost_subform_page_zi_p_code
topmost_subform_page_employees_telephone_number
topmost_subform_page_noncitizen_national_united_states_see_instructions
topmost_subform_page_country_issuance
topmost_subform_page_city_town__2
topmost_subform_page_zip_code
topmost_subform_page_state__1
topmost_subform_page_state__2
topmost_subform_page
topmost_subform_page_date_mmddyyyy
topmost_subform_page_zip_code_employers_business_organization
topmost_subform_page_state__3

Suggested Screen 6:

citizenship_immigration_status

Suggested Screen 7:

topmost_page_last_names_used
topmost_page_use
page_list_document_title__1
topmost_page_list_document_title__1
topmost_page_list_document_title__2
topmost_page_list_document__1
page_list_document_title__2
topmost_page_list_document__2
page_list_document_title__3
topmost_page_list_document__3
topmost_page_document_title

Suggested Screen 8:

topmost_subform_page_alien_authorized_work_expiration_date_applicable_mmd_dd_yyyy
topmost_subform_page_expiration_date_applicable_mm_dd_yyyy
topmost_subform_page_list_expiration_date_mm_dd_yyyy__1
topmost_subform_page_list_b_expiration_date_mm_dd_yyyy
topmost_subform_page_list_c_expiration_date_mm_dd_yyyy
topmost_subform_page_list_expiration_date_mm_dd_yyyy__2
topmost_subform_page_list_expiration_date_mm_dd_yyyy__3
topmost_subform_page_employee_first_day_employment_mm_dd_yyyy

Suggested Screen 9:

topmost_subform_page_list_issuing_authority__1
topmost_list_issuing_authority__1
topmost_list_issuing_authority__2
topmost_subform_page_list_issuing_authority__2
topmost_subform_page_list_issuing_authority__3

Suggested Screen 10:

last_name_representative
first_name_representative

Suggested Screen 11:

foreign_passport_number
employers_business_organization
business_organization_number
city_business_organization

Suggested Screen 12:

topmost_first_name_given__1
address_street_number_name__1
topmost_first_name_given__2
address_street_number_name__2
topmost_first_name_given__3
topmost_first_name_given__4

Suggested Screen 13:

page_employee_section
page_additional_information
page_document_number

Suggested Screen 14:

topmost_expiration_date

Suggested Screen 15:

page_text_field_title
page_text_field_employer

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Employment Eligibility Verification Department of Homeland Security

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02