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Employment Eligibility Verification USCIS <br />;f F Department of Homeland Security Form I -9 <br />OMB No. 1615 -0047 <br />U.S. Citizenship and Immigration Services Expires 03/31/2016 <br />►START HERE. Read instructions carefully before completing this form. The instructions must be available during completion of this form. <br />ANTI -DISCRIMINATION NOTICE: It is illegal to discriminate against work - authorized individuals. Employers CANNOT specify which <br />document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future <br />expiration date may also constitute illegal discrimination. <br />1 am aware that federal law provides for imprisonment and /or fines for false statements or use of false documents in <br />connection with the completion of this form. <br />I attest, under penalty of perjury, that I am (check one of the following): <br />❑ A citizen of the United States <br />❑ A noncitizen national of the United States (See instructions) <br />❑ A lawful permanent resident (Alien Registration Number /USCIS Number): <br />❑ An alien authorized to work until (expiration date, if applicable, mm /dd/yyyy) _ <br />(See instructions) <br />Some aliens may write "N /A" in this field. <br />For aliens authorized to work, provide your Alien Registration.Number /USCIS Number OR Form 1 -94 Admission Number: <br />1. Alien Registration Number /USCIS Number: <br />OR <br />2. Form 1 -94 Admission Number: <br />If you obtained your admission number from CBP in connection with your arrival in the United <br />States, include the following: <br />Foreign Passport Number: <br />Country of Issuance: <br />3 -D Barcode <br />Do Not Write in This Space <br />Some aliens may write "N /A" on the Foreign Passport Number and Country of Issuance fields. (See instructions) <br />Signature of Employee: Date (mm/dd /yyyy): <br />and /or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the <br />I attest, under penalty of perjury, that 1 have assisted in the completion of this form and that to the best of my knowledge the <br />information Is true and correct. <br />of Preparer or Translator: Date (mm/dd/yyyy): <br />Name (Family Name) First Name (Given Name) <br />(Street Number and Name) City or Town State Zip <br />0 Employer Completes Next Page 0 <br />Form 1 -9 03/08/13 N - <br />Page 7 of 9 <br />