I-9 Form - Skilled Staff

I-9: Employment Eligibility Verification

I-9 LIST OF ACCEPTABLE DOCUMENTS

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions.
ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.

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.

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Last Name (Family Name)(Required)

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First Name (Given Name)(Required)

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Middle Initial (if any)(Required)

Name(Required)

First Name (Given Name) Middle Initial (if any) Last Name (Family Name)

Other Last Names Used (if any)

Address (Street Number and Name)(Required)

Apt. Number (if any)

City or Town(Required)

State(Required)

Zip Code(Required)

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Address(Required)

Address (Street Number and Name) Apt. Number (if any) City or Town State ZIP Code

Date of Birth (mm/dd/yyyy)(Required)

U.S. Social Security Number(Required)

Employee's Email Address(Required)

Employee's Telephone Number(Required)

I am aware that federal law provides for imprisonment and/orfines for false statements, or the use of false documents, in connection with the completion ofthis form. I attest, under penaltyof perjury, that this information,including my selection of the boxattesting to my citizenship orimmigration status, is true and correct. Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.):

1. A citizen of the United States

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

3. A lawful permanent resident (Enter USCIS or A-Number.)

Enter USCIS or A-Number

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

exp. date, if any

If you check Item Number 4., enter one of these:

USCIS A-Number

Form I-94 Admission Number

Foreign Passport Number and Country of Issuance

Signature of Employee(Required)

Today's Date (mm/dd/yyyy)(Required)

Supplement A, Preparer and/or Translator Certification for Section 1

Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's completed Form I-9.

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

Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Middle Initial (if any)

Address (Street Number and Name)

City or Town

State

Zip Code

The next page adds your information onto the official I-9 form. All that is required on that page is your signature. It MUST be signed for Skilled Staff to accept your document.