Form I-9 - Seacoast Payroll Services

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Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-9
OMB No. 1615-0047
Expires 10/31/2022

FORM I-9

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

City

State/Province

Zip/Postal

Date of Birth

U.S. Social Security Number

Employee's Email

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

4. An alien authorized to work

(Alien Registration Number/USCIS Number):

until (expiration date, if applicable, mm/dd/yyyy):

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. Please enter in appropriate field below:

1. Alien Registration Number/USCIS Number

2. Form I-94 Admission Number

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee

Clear

Today's Date

Preparer and/or Translator Certification

Check One

I did not use a preparer or translator

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

(Fields below must be completed and signed when preparers 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

Clear

Today's Date

Last Name (Family Name)

Address

City

State/Province

Zip/Postal

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.")

Employee Info from Section 1

Last Name (Family Name)

First Name (Given Name)

M.I.

Citizenship/Immigration Status

LIST A - IDENTITY AND EMPLOYMENT AUTHORIZATION

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

LIST B - IDENTITY

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

LIST C - EMPLOYMENT AUTHORIZATION

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

Section

Signature

Clear

Today's Date

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 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.)

A. New Name (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

B. Date of Rehire (if applicable)

Date

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)