Fillable 1112 I9 (Aims Community College)

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1112 I9 (Aims Community College)

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Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-9, Employment
Eligibility Verification
OMB No. 1615-0047; Expires 08/31/12
Read instructions carefully before completing this form. The instructions must be available during completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT
specify which document(s) they will accept from an employee. The refusal to hire an individual because the documents have a
future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Verification (To be completed and signed by employee at the time employment begins.)
Print Name: Last First Middle Initial
Maiden Name
Address (Street Name and Number)
Apt. # Date of Birth (month/day/year)
StateCity Zip Code Social Security #
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.
Employee's Signature
Date (month/day/year)
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the employee.) I attest, under
penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the information is true and correct.
Address (Street Name and Number, City, State, Zip Code)
Print NamePreparer's/Translator's Signature
Date (month/day/year)
Section 2. Employer Review and Verification (To be completed and signed by employer. Examine one document from List A OR
examine one document from List B and one from List C, as listed on the reverse of this form, and record the title, number, and
expiration date, if any, of the document(s).)
ANDList B List CORList A
Document title:
Issuing authority:
Document #:
Expiration Date (if any):
Document #:
Expiration Date (if any):
and that to the best of my knowledge the employee is authorized to work in the United States. (State
(month/day/year)
employment agencies may omit the date the employee began employment.)
CERTIFICATION: I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee, that
the above-listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on
Print Name TitleSignature of Employer or Authorized Representative
Date (month/day/year)Business or Organization Name and Address (Street Name and Number, City, State, Zip Code)
B. Date of Rehire (month/day/year) (if applicable)A. New Name (if applicable)
C. If employee's previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization.
Document #: Expiration Date (if any):Document Title:
Section 3. Updating and Reverification (To be completed and signed by employer.)
l 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) l have examined appear to be genuine and to relate to the individual.
Date (month/day/year)Signature of Employer or Authorized Representative
I attest, under penalty of perjury, that I am (check one of the following):
A lawful permanent resident (Alien #)
A citizen of the United States
An alien authorized to work (Alien # or Admission #)
A noncitizen national of the United States (see instructions)
until (expiration date, if applicable - month/day/year)
Form I-9 (Rev. 08/07/09) Y Page 4
For persons under age 18 who
are unable to present a
document listed above:
LISTS OF ACCEPTABLE DOCUMENTS
LIST A LIST B LIST C
2. Permanent Resident Card or Alien
Registration Receipt Card (Form
I-551)
8. Employment authorization
document issued by the
Department of Homeland Security
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
1. Social Security Account Number
card other than one that specifies
on the face that the issuance of the
card does not authorize
employment in the United States
9. Driver's license issued by a Canadian
government authority
1. U.S. Passport or U.S. Passport Card
2. Certification of Birth Abroad
issued by the Department of State
(Form FS-545)
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)
3. Certification of Report of Birth
issued by the Department of State
(Form DS-1350)
3. School ID card with a photograph
5. In the case of a nonimmigrant alien
authorized to work for a specific
employer incident to status, a foreign
passport with Form I-94 or Form
I-94A bearing the same name as the
passport and containing an
endorsement of the alien's
nonimmigrant status, as long as the
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. Military dependent's ID card
4. Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal
7. U.S. Coast Guard Merchant Mariner
Card
5. Native American tribal document
8. Native American tribal document
7. Identification Card for Use of
Resident Citizen in the United
States (Form I-179)
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record
Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)
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
4. Voter's registration card
5. U.S. Military card or draft record
Documents that Establish Both
Identity and Employment
Authorization
Documents that Establish
Identity
Documents that Establish
Employment Authorization
OR
AND
All documents must be unexpired
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
6. U.S. Citizen ID Card (Form I-197)
Form I-9 (Rev. 08/07/09) Y Page 5
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1112 I9 (Aims Community College)

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Completed 22 July 2020

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