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.)

First Name *

M.I.

Last Name (Family Name) *

Suffix

Other Last Name Used (if any)

Address (Number and Street) *

Apt Number

City or Town *

State *

ZIP Code *

Date of Birth * +

U.S. Social Security Number *

Employee's Telephone Number *

Link to USCIS Form I-9 Instructions (for reference only)

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

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

4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp date, if any, to be entered below in the Work expiration date field)

USCIS or A-Number *

Work expiration date *

I checked Item Number 4. above *

Yes

USCIS A-Number:

Form I-94 Admission Number:

Foreign Passport Number and 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.)

Signature of Preparer or Translator

clear

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

First Name (Given Name)

Last Name (Family Name)

Address (Street Number and Name)

City or Town

State

ZIP Code