Form I-9, Employment Eligibility Verification Instructions
This form contains 128 fields organized into 33 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Information | ||
| Additional Information Details | Text |
Provide any additional documentation details or information not covered elsewhere in the form.
|
| Alternative Procedure Checkbox | ||
| Alternative Procedure | Checkbox |
Check this box if an alternative procedure authorized by DHS was used to examine the employee's documents.
CB_Alt
|
| Citizenship/Immigration Status Attestation | ||
| Citizen of the United States | Checkbox |
Check this box if you are a citizen of the United States.
CB_1
|
| Noncitizen National of the United States | Checkbox |
Check this box if you are a noncitizen national of the United States.
|
| Lawful Permanent Resident USCIS A-Number | Text |
Provide your USCIS or A-Number if you are a lawful permanent resident. Fill only if 'Lawful Permanent Resident' is 'Yes'.
Depends on:
Lawful Permanent Resident
|
| Lawful Permanent Resident | Checkbox |
Check this box if you are a lawful permanent resident, then enter your USCIS or A-Number.
|
| Work Authorization Expiration Date | Date |
Provide the expiration date until which you are authorized to work. Fill only if 'Authorized Noncitizen' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Authorized Noncitizen | Checkbox |
Check this box if you are a noncitizen (other than a noncitizen national or lawful permanent resident) authorized to work, then provide your employment authorization expiration date if applicable and required documentation details.
|
| Employee Address | ||
| Street Address | Text |
Enter the street number and name of the employee's residential address.
|
| Apartment Number | Text |
Enter the apartment, suite, or unit number of the employee's residential address, if applicable.
|
| City or Town | Text |
Enter the city or town of the employee's residential address.
|
| State | Combobox |
Enter the U.S. state where the employee resides using the standard two-letter postal abbreviation.
WA
SC
AZ
NH
OR
FL
GA
IL
NM
TX
DE
WV
OK
GU
MA
NE
UT
VI
MD
MEX
VT
RI
AR
MT
IA
AK
KY
MS
CAN
PA
WI
AL
VA
PR
CT
LA
SD
AS
NJ
NY
CO
ID
CA
TN
NV
OH
HI
KS
MO
ME
ND
MP
NC
DC
WY
IN
MN
MI
|
| ZIP Code | Text |
Enter the five-digit ZIP code or nine-digit ZIP+4 code of the employee's residential address.
|
| Employee Name | ||
| First Name | Text |
Enter the employee's first name or given name.
|
| Middle Initial | Text |
Enter the employee's middle initial, if applicable.
|
| Last Name | Text |
Enter the employee's last name or family name.
|
| Other Last Names Used | Text |
Enter any other last names the employee has used, if applicable.
|
| Employee Name from Section 1 | ||
| Employee Last Name | Text |
Please provide the employee's last name (family name) as it was entered in Section 1.
|
| Employee First Name | Text |
Please provide the employee's first name (given name) as it was entered in Section 1.
|
| Employee Middle Initial | Text |
Please provide the employee's middle initial, if applicable, as it was entered in Section 1.
|
| Employee Personal and Contact Information | ||
| Employee Telephone Number | Text |
Please provide the employee's telephone number.
|
| Employee Email Address | Text |
Please provide the employee's email address.
|
| U.S. Social Security Number | Text |
Please provide the employee's U.S. Social Security Number.
|
| Date of Birth | Date |
Please provide the employee's date of birth.
|
| Employee Signature Date | ||
| Employee Signature Date | Date |
Provide the date the employee signed the form.
|
| Employer Attestation | ||
| Employer or Authorized Representative Name | Text |
Please enter the name of the employer or authorized representative. Fill only if 'Citizenship/Immigration Status' is 'A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)'
Depends on:
Authorized Noncitizen
|
| Attestation Date | Date |
Please enter today's date. Fill only if 'Citizenship/Immigration Status' is 'A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)'
Depends on:
Authorized Noncitizen
|
| Employer Certification | ||
| Employer or Authorized Representative Name and Title | Text |
Enter the last name, first name, and title of the employer or authorized representative.
|
| Employer Business or Organization Name | Text |
Enter the name of the employer's business or organization.
|
| Employer Business or Organization Address | Text |
Enter the complete business or organization address, including city, town, state, and ZIP code.
|
| First Day of Employment | Date |
Enter the employee's first day of employment.
|
| Today's Date | Date |
Enter today's date.
|
| First Additional Information | ||
| Additional Information | Text |
Please provide any additional information, including initials and the date for each notation.
|
| DHS Alternative Procedure | Checkbox |
Check this box if you used an alternative procedure authorized by the Department of Homeland Security (DHS) to examine the employee's documents.
CB_Alt_0
|
| First Employer Signature | ||
| Employer or Authorized Representative Name | Text |
Enter the full name of the employer or authorized representative who is signing the form.
|
| Signature Date | Date |
Enter the date the employer or authorized representative signed the form.
|
| First Preparer/Translator Information | ||
| Preparer First Name | Text |
Enter the first name of the preparer or translator.
|
| Preparer Middle Initial | Text |
Enter the middle initial of the preparer or translator, if applicable.
|
| Preparer Last Name | Text |
Enter the last name of the preparer or translator.
|
| Preparer City or Town | Text |
Enter the city or town where the preparer or translator resides.
|
| First Preparer/Translator State | Combobox |
Enter the state of the first preparer or translator’s residence.
WA
SC
AZ
NH
OR
FL
GA
IL
NM
TX
DE
WV
OK
GU
MA
NE
UT
VI
MD
MEX
VT
RI
AR
MT
IA
AK
KY
MS
CAN
PA
WI
AL
VA
PR
CT
LA
SD
AS
NJ
NY
CO
ID
CA
TN
NV
OH
HI
KS
MO
ME
ND
MP
NC
DC
WY
IN
MN
MI
|
| Preparer ZIP Code | Text |
Enter the ZIP code of the preparer or translator's address.
|
| Preparer Street Address | Text |
Enter the street number and name of the preparer or translator's address.
|
| Preparer Certification Date | Date |
Enter the date the preparer or translator signed this certification.
|
| First Rehire Name and Date | ||
| New Last Name | Text |
Please enter the employee's new last name, if applicable.
|
| New First Name | Text |
Please enter the employee's new first name, if applicable.
|
| New Middle Initial | Text |
Please enter the employee's new middle initial, if applicable.
|
| Rehire Date | Date |
Please enter the date the employee was rehired, if applicable.
|
| First Reverification Document | ||
| First Reverification Document Number | Text |
Please provide the document number for the first reverification document. Fill only if 'A noncitizen authorized to work' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| First Reverification Document Expiration Date | Date |
Please provide the expiration date of the first reverification document. Fill only if 'A noncitizen authorized to work' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Fourth Preparer/Translator Information | ||
| Last Name | Text |
Please provide the last name or family name of the preparer or translator.
|
| First Name | Text |
Please provide the first name or given name of the preparer or translator.
|
| Middle Initial | Text |
Please provide the middle initial of the preparer or translator, if applicable.
|
| Fourth Preparer/Translator State | Combobox |
Enter the state of the fourth preparer or translator’s address.
WA
SC
AZ
NH
OR
FL
GA
IL
NM
TX
DE
WV
OK
GU
MA
NE
UT
VI
MD
MEX
VT
RI
AR
MT
IA
AK
KY
MS
CAN
PA
WI
AL
VA
PR
CT
LA
SD
AS
NJ
NY
CO
ID
CA
TN
NV
OH
HI
KS
MO
ME
ND
MP
NC
DC
WY
IN
MN
MI
|
| City or Town | Text |
Please provide the city or town for the preparer or translator's address.
|
| ZIP Code | Text |
Please provide the ZIP code for the preparer or translator's address.
|
| Street Address | Text |
Please provide the street number and name for the preparer or translator's address.
|
| Certification Date | Date |
Please provide the date the preparer or translator signed this certification.
|
| General | ||
| Signature_1 | Signature | |
| Signature_2 | Signature | |
| Signature_3 | Signature | |
| Signature_4 | Signature | |
| Signature_5 | Signature | |
| Signature_6 | Signature | |
| Signature_7 | Signature | |
| Signature_8 | Signature | |
| Signature_9 | Signature | |
| Instructions | ||
| New Last Name | Text |
Enter the employee's new last name, if applicable.
|
| New First Name | Text |
Enter the employee's new first name, if applicable.
|
| New Middle Initial | Text |
Enter the employee's new middle initial, if applicable.
|
| Date of Rehire | Date |
Provide the date the employee was rehired, if applicable.
|
| List A Document 1 | ||
| Issuing Authority | Text |
Enter the name of the authority that issued the List A document.
|
| Document Number | Text |
Enter the document number of the List A document.
|
| Document Title | Text |
Enter the official title of the List A document.
|
| Expiration Date | Date |
Enter the expiration date of the List A document.
|
| List A Document 2 | ||
| Document Title 2 | Text |
Please enter the title of the second document from List A.
|
| Issuing Authority 2 | Text |
Please enter the name of the authority that issued the second document from List A.
|
| Document Number 2 | Text |
Please enter the document number of the second document from List A.
|
| Expiration Date 2 | Date |
Please enter the expiration date of the second document from List A.
|
| List A Document 3 | ||
| Document Title 3 | Text |
Enter the title of the third document provided from List A.
|
| Issuing Authority 3 | Text |
Enter the name of the authority that issued the third document from List A.
|
| Document Number 3 | Text |
Enter the document number of the third document from List A.
|
| Expiration Date 3 | Date |
Enter the expiration date of the third document from List A.
|
| List B Document | ||
| List B Document Title | Text |
Enter the title of the identity document provided from List B.
|
| List B Issuing Authority | Text |
Enter the name of the authority that issued the List B document.
|
| List B Document Number | Text |
Enter the document number of the identity document provided from List B.
|
| List B Expiration Date | Date |
Enter the expiration date of the identity document provided from List B.
|
| List C Document | ||
| List C Document Title | Text |
Enter the title of the List C document presented by the employee.
|
| List C Issuing Authority | Text |
Enter the name of the authority that issued the List C document.
|
| List C Document Number | Text |
Enter the document number from the List C document.
|
| List C Expiration Date | Date |
Enter the expiration date of the List C document.
|
| Noncitizen Documentation | ||
| USCIS A-Number | Text |
Please provide your USCIS Alien Registration Number (A-Number). Fill only if 'Authorized Noncitizen' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Form I-94 Admission Number | Text |
Please provide your Form I-94 Admission Number. Fill only if 'Authorized Noncitizen' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Foreign Passport Number and Country of Issuance | Text |
Please provide your foreign passport number and the country that issued it. Fill only if 'Authorized Noncitizen' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Reverification Document Information | ||
| Document Title | Text |
Please enter the title of the document presented for reverification. Fill only if 'Citizenship/Immigration Status' is 'A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)'
Depends on:
Authorized Noncitizen
|
| Document Number | Text |
Please enter the document number from the document presented for reverification. Fill only if 'Citizenship/Immigration Status' is 'A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)'
Depends on:
Authorized Noncitizen
|
| Expiration Date | Date |
Please enter the expiration date of the document presented for reverification. Fill only if 'Citizenship/Immigration Status' is 'A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)'
Depends on:
Authorized Noncitizen
|
| Second Additional Information | ||
| Second Additional Information Notation | Text |
Provide any additional information, including your initials and the date for each notation.
|
| DHS Alternative Procedure | Checkbox |
Check this box if an alternative procedure authorized by DHS was used to examine the employee's documents.
CB_Alt_1
|
| Second Employer Signature | ||
| Employer or Authorized Representative Name | Text |
Provide the full name of the employer or authorized representative who is signing the form.
|
| Signature Date | Date |
Provide the date the employer or authorized representative signed the form.
|
| Second Preparer/Translator Information | ||
| Preparer Last Name | Text |
Please provide the last name of the second preparer or translator.
|
| Preparer Middle Initial | Text |
Please provide the middle initial of the second preparer or translator, if applicable.
|
| Preparer City or Town | Text |
Please enter the city or town where the second preparer or translator resides.
|
| Second Preparer/Translator State | Combobox |
Enter the state of the second preparer or translator’s address.
WA
SC
AZ
NH
OR
FL
GA
IL
NM
TX
DE
WV
OK
GU
MA
NE
UT
VI
MD
MEX
VT
RI
AR
MT
IA
AK
KY
MS
CAN
PA
WI
AL
VA
PR
CT
LA
SD
AS
NJ
NY
CO
ID
CA
TN
NV
OH
HI
KS
MO
ME
ND
MP
NC
DC
WY
IN
MN
MI
|
| Preparer ZIP Code | Text |
Please provide the ZIP code for the address of the second preparer or translator.
|
| Preparer Street Address | Text |
Please enter the street number and name for the address of the second preparer or translator.
|
| Date Prepared | Date |
Please enter the date the second preparer or translator completed this section.
|
| Second Rehire Name and Date | ||
| Second Rehire Last Name | Text |
Please enter the employee's new last name for the second rehire event.
|
| Second Rehire First Name | Text |
Please enter the employee's new first name for the second rehire event.
|
| Second Rehire Middle Initial | Text |
Please enter the employee's new middle initial for the second rehire event, if applicable.
|
| Second Rehire Date | Date |
Please provide the date of the second rehire for the employee.
|
| Second Reverification Document | ||
| Document Title | Text |
Enter the title of the document presented for reverification. Fill only if 'A noncitizen authorized to work' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Document Number | Text |
Enter the document number of the presented document, if applicable. Fill only if 'A noncitizen authorized to work' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Document Expiration Date | Date |
Enter the expiration date of the presented document, if applicable. Fill only if 'A noncitizen authorized to work' is 'Yes'.
Depends on:
Authorized Noncitizen
|
| Supplement B, Reverification and Rehire (formerly Section 3) | ||
| Last Name (Family Name) | Text |
Please provide the employee's last name (family name) exactly as it appeared in Section 1. Fill only if 'Reverification or Rehire' is required
|
| First Name (Given Name) | Text |
Please provide the employee's first name (given name) exactly as it appeared in Section 1. Fill only if 'Reverification or Rehire' is required
|
| Middle Initial | Text |
Please provide the employee's middle initial, if any, exactly as it appeared in Section 1. Fill only if 'Reverification or Rehire' is required
|
| Third Additional Information | ||
| Third Additional Information | Text |
Provide any additional information, including initials and the date for each notation, related to the third reverification or rehire event.
|
| Used DHS Alternative Procedure | Checkbox |
Check this box if you used an alternative procedure authorized by DHS to examine documents.
|
| Third Preparer/Translator Information | ||
| Third Preparer Last Name | Text |
Please provide the last name (family name) of the third preparer or translator.
|
| Third Preparer First Name | Text |
Please provide the first name (given name) of the third preparer or translator.
|
| Third Preparer Middle Initial | Text |
Please provide the middle initial of the third preparer or translator, if applicable.
|
| Third Preparer/Translator State | Combobox |
Enter the state of the third preparer or translator’s address using the two-letter postal abbreviation.
WA
SC
AZ
NH
OR
FL
GA
IL
NM
TX
DE
WV
OK
GU
MA
NE
UT
VI
MD
MEX
VT
RI
AR
MT
IA
AK
KY
MS
CAN
PA
WI
AL
VA
PR
CT
LA
SD
AS
NJ
NY
CO
ID
CA
TN
NV
OH
HI
KS
MO
ME
ND
MP
NC
DC
WY
IN
MN
MI
|
| Third Preparer Street Address | Text |
Please provide the street number and name for the third preparer or translator's address.
|
| Third Preparer City | Text |
Please provide the city or town for the third preparer or translator's address.
|
| Third Preparer ZIP Code | Text |
Please provide the ZIP code for the third preparer or translator's address.
|
| Third Preparer Certification Date | Date |
Please provide the date the third preparer or translator certified the information.
|