Form I-9 Presentation by Sharon Silverberg

FORM I-9

REDESIGNED OCTOBER 2009

FORM I-9 is the Employee Eligibility Verification Form

issued by U.S. Citizenship and Immigration Services. It is used by employers to verify an employeeâ&#x20AC;&#x2122;s identity and establish that the worker is eligible to work in the U.S. It is terribly designed.

the current form i-9

the new form i-9

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION. 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 & Verification (To be completed and signed by employee at the time employment begins.)

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 NAME (Last, First Middle, Maiden*)

ADDRESS (Street No. & Name, Apartment No.)

CHECK ONE OF THE FOLLOWING. I

DATE OF BIRTH (mm/dd/yyyy)

An alien authorized to work until a certain date

ALIEN NO./ADMISSION NO.

U.S. Passport or U.S. Passport Card

Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.

Social Security Account Number card excluding one which specifies that the issuance of the card does not authorize employment in the U.S.

PREPARER/TRANSLATOR NAME

Foreign passport containing temporary I-551 stamp or printed notation on a machine-readable immigrant visa

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Section 2. Employer Review & Verification (To be completed and signed by employer.)

{

B C +

}

LIST B

EXAMINE ONE DOCUMENT FROM List

A OR List B & List C as listed on the reverse of this form. Record all information for each of the appropriate document(s) without abbreviations.

HIRE DATE

ISSUING AUTHORITY

DOCUMENT NO.

LIST A

I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine, and that the employee began employment on

DOCUMENT TITLE

DATE

To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.

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.

ADDRESS

EXP. DATE

B+C

LIST C

attest, under penalty of perjury, that I am:

A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident of the United States ALIEN NO.

LIST B

DATE

(To be completed and signed if Section 1 is prepared by a person other than the employee.)

SOCIAL SECURITY NO. (xxx-xx-xxxx)

LIST A

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

Preparer and/or Translator Certification* (City, State, Zip Code)

ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the M-274 Handbook for Employers Part 8.

EMPLOYER’S NAME/TITLE

DOCUMENTS THAT ESTABLISH BOTH IDENTITY AND EMPLOYMENT AUTHORIZATION

Permanent Resident Card or I-551 Resident Alien Card

I-766 Employment Authorization Form that contains a photograph

Foreign passport with I-94 or I-94A bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer; contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with I-94 or I-94A indicating non-immigrant admission

DOCUMENTS THAT ESTABLISH ONLY IDENTITY

Federal, state, or locally issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address. School ID card with a photograph Voter’s Registration Card U.S. Military Card or draft record U.S. Military dependent’s ID card U.S. Coast Guard Merchant Mariner Card Native American tribal document Canadian driver’s license

DOCUMENT TITLE

LIST C

BUSINESS/ORGANIZATION NAME

ISSUING AUTHORITY

DOCUMENT TITLE

ADDRESS (Street No. & Name)

ISSUING AUTHORITY

(City, State, Zip Code)

FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE

School record or report card DOCUMENT NO.

DATE

DOCUMENT NO.*

DATE*

DOCUMENT NO.

Clinic, doctor, or hospital record DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Day care or nursery school record

Section 3. Updating & Reverification* (To be completed and signed by employer.) NEW NAME*

DATE OF REHIRE*

If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization. DOCUMENT TITLE

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENT NO.

EXP. DATE

I 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) I have examined appear to be genuine and to relate to the individual.

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

*Fill out only if applicable

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENTS THAT ESTABLISH ONLY EMPLOYMENT AUTHORIZATION

FS-545 Certification of Birth Abroad issued by the Department of State DS-1350 Certification of Report of Birth issued by the Department of State

Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S. I-197

U.S. Citizen ID Card

Identification Card for use of Resident Citizen in the United States I-179

Native American tribal document Employment authorization document issued by the Department of Homeland Security

the redesign process

1. ASSESS CURRENT POSITION. Define the uses of the form, its audience, and effectiveness.

2. DEFINE CHALLENGES. Identify problem areas and ambiguities.

3. REFINE CONTENT. Refine language, grouping, and hierarchy.

4. REDESIGN. Recreate and make adjustments in Illustrator.

5. REFINE. Assess redesign & make edits.

assessing the current form

AS A USER What do I fill out? What does my employer fill out? Where do I sign? Where does it say what day I get hired? How many documents do I need? Is it better to use one document over another?

assessing the current form

AS A USER

AS A DESIGNER

What do I fill out?

How can the grouping/typographic hierarchy be clarified?

What does my employer fill out? Where do I sign? Where does it say what day I get hired? How many documents do I need? Is it better to use one document over another?

Can I eliminate some of the extraneous lines and language? How can the form become more open and user-friendly? How can the form get more consistent?

defining the challenges

GROUPING Types of information Who fills out what {(A or B) & C} vs {A or (B & C)}

HIERARCHY 1. Form title/header 2. Section titles/instructions 3. Document information 4. Identifying information 5. Signature indications 6. Government numbers/footer

refining the content

LINGUISTIC CLARITY Editing unnessarily confusing language Considering potentially foreign audience

LEGAL MATTERS Researching the form verification process Understanding common mistakes

redesigning & refining

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

OMB No. 1615-0047; Expires 08/31/12

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

OMB No. 1615-0047; Expires 08/31/12

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.

ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Emploers (M-274) Part 8. To be eligible for employment, employee must provide either one document from list A, or one document each from list B and C.

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 & Verification (To be completed and signed by employee at the time employment begins.) 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 NAME

Last, First Middle (Maiden if applicable) ADDRESS

EMPLOYEE SIGNATURE

Street No. & Name, Apartment No.

DATE

Preparer and/or Translator Certification

City, State, Zip Code SOCIAL SECURITY NO.

(To be completed and signed if Section 1 is prepared by a person other than the employee.)

DATE OF BIRTH

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.

CHECK ONE OF THE FOLLOWING. I

attest, under penalty of perjury, that I am: A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) ALIEN NO. A lawful permanent resident An alien authorized to work

ALIEN NO./ADMISSION NO.

PREPARER/TRANSLATOR NAME

DATE

ADDRESS

EXP. DATE

Street No. & Name, City, State, Zip Code PREPARER/TRANSLATOR SIGNATURE

DATE

Section 2. Employer Review & Verification (To be completed and signed by employer.)

LIST A

EXAMINE ONE DOCUMENT FROM

{

B+C

}

DOCUMENT TITLE

List A OR B & C as listed on the reverse of this form. Record all listed information for each of the document(s) without abbreviations. Pay special attention to issuing authority and expiration dates, where applicable.

LIST B

ISSUING AUTHORITY

DOCUMENT NO.

EXP. DATE

DOCUMENT NO.

EXP. DATE

I attest, under penalty of perjury, that I have examined the document(s) presented by the above-named employee that the listed document(s) appear to be genuine and to relate to the employee named, that the employee began employment on HIRE DATE

Social Security Account Number card excluding one which specifies that the issuance of the card does not authorize employment in the U.S.

Federal, state, or locally issued ID card provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.

FS-545 Certification of Birth Abroad issued by the Department of State

Foreign passport containing temporary I-551 stamp or printed notation on a machinereadable immigrant visa I-766 Employment Authorization Form that contains a photograph

Foreign passport with I-94 or I-94A bearing the same name as the passport and containing an endorsement of the alien’s nonimmigration status, in the case of a nonimmigrant alien authorized to work for a specific employer. Contingent on unexpired status and that the proposed employment does not conflict with any stated restrictions. Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with I-94 or I-94A indicating non-immigrant admission.

DOCUMENT NO.

EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE

DATE OF REHIRE (IF APPLICABLE)

DOCUMENT TITLE

DOCUMENT NO.

EXP. DATE

Form I-9 (Rev. 08/07/09) Y Page 4

U.S. Military Card or draft record U.S. Military dependent’s ID card U.S. Coast Guard Merchant Mariner Card

Day care or nursery school record DATE

DATE

Form I-9 (Rev. 08/07/09) Y Page 5

DOCUMENTS THAT ESTABLISH EMPLOYMENT AUTHORIZATION

DS-1350 Certification of Report of Birth issued by the Department of State

Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S. I-197

U.S. Citizen ID Card

Identification Card for use of Resident Citizen in the United States I-179

Native American tribal document Native American tribal document

Clinic, doctor, or hospital record

I 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. EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE

Voter’s Registration Card

School record or report card DATE

Section 3. Updating & Reverification (To be completed and signed by employer.) NEW NAME (IF APPLICABLE)

School ID card with a photograph

FOR PERSONS UNDER AGE 18 WHO ARE UNABLE TO PRESENT ANY DOCUMENT ABOVE

BUSINESS/ORGANIZATION NAME

EXP. DATE

DOCUMENTS THAT ONLY ESTABLISH IDENTITY

Canadian driver’s license

ISSUING AUTHORITY

EXP. DATE

}

Driver’s license or state-issued ID card provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.

Permanent Resident Card or I-551 Resident Alien Card

Street No. & Name, City, State, Zip Code DOCUMENT NO.

B+C

U.S. Passport or U.S. Passport Card

EMPLOYER’S NAME, TITLE

ADDRESS

LIST C

DOCUMENTS THAT ESTABLISH BOTH IDENTITY AND EMPLOYMENT AUTHORIZATION

DOCUMENT TITLE

ISSUING AUTHORITY

LIST B

and that to the best of my knowledge the employee is authorized to work in the U.S.

LIST C

DOCUMENT TITLE

{ LIST A

Employment authorization document issued by the Department of Homeland Security

redesigning & refining

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

OMB No. 1615-0047; Expires 08/31/12

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.

ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the Handbook for Emploers (M-274) Part 8. BE UNEXPIRED. Illustrations of many of thesefrom documents in document the M-274 each Handbook To be eligibleALL for DOCUMENTS employment,MUST employee must provide either one document list A,appear or one fromfor listEmployers B and C.Part 8.

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

READ INSTRUCTIONS COMPLETING THIS FORM. THE individuals. INSTRUCTIONS MUST BE AVAILABLE COMPLETION. ANTI-DISCRIMINATION NOTICE: It CAREFULLY is illegal to BEFORE discriminate against work-authorized Employers cannot specifyDURING which document(s) they will It individual is illegal tobecause discriminate against work-authorized individuals.date Employers cannot specifyillegal whichdiscrimination. document(s) they will accept from anANTI-DISCRIMINATION employee. The refusal NOTICE: to hire an the documents have a future expiration may also constitute 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 & Verification (To be completed and signed by employee at the time employment begins.) Section 1. Employee Information & Verification EMPLOYEE NAME

I am aware that federal law provides for imprisonment and/or fines for false statements I am aware that federal law provides for imprisonment or use of false documents in connection with and/or fines for false statements or use of false documents the completion of this form. in connection with the completion of this form.

(To be completed and signed by employee at the time employment begins.)

Last, First Middle (Maiden if applicable) ADDRESS

EMPLOYEE NAME (Last, First Middle, Maiden*)

EMPLOYEE SIGNATURE

Street No. & Name, Apartment No. ADDRESS (Street No. & Name, Apartment No.)

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Preparer and/or Translator Certification* Preparer and/or Translator Certification

City, State, Zip Code

(City, State, Zip Code)

SOCIAL SECURITY NO.

(To be and signed 1 if is Section 1 is prepared by a person (To be completed andcompleted signed if Section prepared other than the employee.) by a person other than the employee.)

DATE OF BIRTH

I attest, under penalty of perjury, that I have assisted

SOCIAL NO. (xxx-xx-xxxx) CHECK ONE OF THE SECURITY FOLLOWING. I attest, under

OF BIRTH (mm/dd/yyyy) penalty ofDATE perjury, that I am:

A citizen of CHECK the United States ONE OF THE FOLLOWING. I attest, under penalty of perjury, that I am: A noncitizenAnational theUnited United States (SEE INSTRUCTIONS) citizen ofofthe States ALIEN NO. A lawful permanent resident A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident ALIEN NO./ADMISSION NO. An alien authorized to work of the United States ALIEN NO. An alien authorized to work until a certain date

I attest, under penalty of perjury, thatand I have in the completion of this form that to the best of my assisted in the completion of this form and that knowledge the information is true. to the best of my knowledge the information is true and correct. PREPARER/TRANSLATOR NAME PREPARER/TRANSLATOR NAME

ADDRESS

EXP. DATE

DATE

ADDRESS

Street No. & Name, City, State, Zip Code PREPARER/TRANSLATOR SIGNATURE

EXP. DATE

ALIEN NO./ADMISSION NO.

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Section 2. Employer Review & Verification (To be completed and signed by employer.) Section 2. Employer Review & Verification EXAMINE ONE DOCUMENT FROM and signed by employer.) I attest, under penalty of perjury, that I have (To be completed LIST A examined the document(s) presented by the DOCUMENT TITLE LIST B A OR B{+ CA OR B + C } above-named employee that the listed

{

}

I attest, under penalty of perjury, that I have examined

ONE DOCUMENT FROM List A OR ISSUING AUTHORITY List A OR B &EXAMINE C as listed on the reverse DOCUMENT TITLE B & List C as listed on the reverse of this form.List Record all listed information of this form. Record all information DOCUMENT NO. for each of the document(s) without ISSUING AUTHORITY for each of the appropriate document(s) abbreviations. Pay special attention to without DOCUMENT NO. issuing authority andabbreviations. expiration dates, where applicable. DOCUMENT NO.

EXP. DATE

LIST B

DOCUMENT TITLE

LIST C

DOCUMENT TITLE

document(s)the appear to be genuine relate document(s) presented and by thetoabove-named employee to the employee named, the employee that the listed that document(s) appear to be genuine, and that the employee began employment on HIRE DATE began employment on

LIST C

B C

DOCUMENTS THAT ESTABLISH BOTH IDENTITY ANDTo EMPLOYMENT AUTHORIZATION + OR

U.S. Passport or U.S. Passport Card Permanent Resident Card or I-551 Resident Alien Card

LIST A

DOCUMENTS THAT ESTABLISH BOTH

DOCUMENT TITLE

ADDRESS (Street No. & Name)

EXP. DATE

DOCUMENT NO.

DATE

DOCUMENT NO.*

DATE*

ISSUING AUTHORITY

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE

(City, State, Zip Code)

DATE

DATE OF REHIRE (IF APPLICABLE)

(To be completed and signed by employer.) NEW NAME*

DOCUMENT NO.

DATE OF REHIRE*

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENT NO.

LIST C

Driver’s license or state-issued ID card provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.

Social Security Account Number card excluding one which specifies that the issuance of the card does not authorize employment in the U.S.

DOCUMENTS THAT ONLY ESTABLISH IDENTITY DOCUMENTS THATone ESTABLISH EMPLOYMENT be eligible for employment, employee must provide either document from AUTHORIZATION List A or one document each from Lists B and C.

LIST B

DOCUMENTS THAT ESTABLISH ONLY

FOR PERSONS UNDER AGE 18 WHO ARE

Day care or nursery school record School record or report card

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Day care or nursery school record

EXP. DATE

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and I attest, under penalty of perjury, the that to the best of my if the employee presented document(s), this employee is authorized document(s)knowledge, l have examined appear to be to work in the States, and if the employee presented document(s), genuine and United to relate to the individual.

If employee’s previous grant of work authorization has expired, provide the information the document(s) I have examined appear to be genuine EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE DATE and to relate to the individual. below for the document that establishes current employment authorization.

Form I-9 (Rev. 08/07/09) DOCUMENT TITLE Y Page 4

}

Clinic, doctor, or hospital record

DOCUMENT NO.

Section 3. Updating & Reverification* DOCUMENT TITLE

B+C

Clinic, doctor, or UNABLE hospitalTOrecord PRESENT ANY DOCUMENT ABOVE

Section 3. Updating & Reverification (To be completed and signed by employer.) NEW NAME (IF APPLICABLE)

School record or report card DATE

Street No. & Name, City, State, Zip Code DOCUMENT NO.

LIST B

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

*Fill out only if applicable

LIST C

DOCUMENTS THAT ESTABLISH ONLY

IDENTITY AND EMPLOYMENT AUTHORIZATION IDENTITY EMPLOYMENT AUTHORIZATION Foreign passport containing temporary I-551 FS-545 Certification of Birth Abroad Federal, state, or locally issued ID card stamp or printed notation on a machineissued by the Department of State provided it contains a photograph or readable immigrant visa Social Security Account Number card license or birth, state-issued ID U.S. Passport or U.S. Passport Card information such Driver’s as name, date of excluding one which specifies that the card, provided it contains a photo DS-1350 Certification of Report of Birth gender, height, eye color and address. I-766 Employment Authorization Form issuance of of theState card does not authorize and/or information such as name, Permanent Resident Card or issued by the Department that contains a photograph I-551 employment in the U.S. date of birth, gender, height, eye Resident Alien Card School ID card with a photograph color and address. Original or certified copy of birth I-94 or I-94A bearing Foreign passport FS-545 Certification of Birth Abroad Foreignwith passport containing temporary I-551 certificate bearing an official seal and the same name asorthe passport and containing issued by the Department of State Federal, ID by a state, stamp printed notation on a machine-readable Voter’s Registration Card state, or locally issued issued county, municipal an endorsement of thevisa alien’s nonimmigration card, provided it contains a photo immigrant authority or territory of the U.S. status, in the case of a nonimmigrant alien DS-1350 Certification of Report of Birth and/or information or draft record such as name, authorized to workEmployment for a specific employer. Form U.S. Military Carddate I-766 issued by the Department of State of birth, gender, height, I-197 eye U.S. Citizen Authorization ID Card Contingent that on unexpired and that the color and address. contains astatus photograph U.S. Military dependent’s ID card proposed employment does not conflict with Original or for certified I-179 Identification Card use ofcopy of birth any stated restrictions. bearing an official seal and School ID card with a photograph Foreign passport with I-94 or I-94A bearing Resident Citizencertificate in the United States issued by a state, county, municipal the same name as the passport and containing U.S. Coast Guard Merchant Mariner Card Passport from the Federal States Micronesia authority or territory Voter’s Registration Card an endorsement of theofalien’s nonimmigration Native American tribal document of the U.S. (FSM) or the Republic of case the Marshall Islands alien status, in the of a nonimmigrant Native American tribal document I-94 or I-94A (RMI) with authorized indicating I-197 U.S. Citizen ID Card U.S. Military Card or draft record to work for a specific employer; Employment authorization document non-immigrant admission. contingent on unexpired status and that the issued by the Department of Homeland Canadian driver’s license I-179 Identification Card for use of U.S. Military dependent’s ID card proposed employment does not conflict with Security Resident Citizen in the United States any stated restrictions U.S. Coast Guard Merchant Mariner Native American tribal document Card Passport from the Federal States of Micronesia (FSM) or the Republic of the Marshall Islands FOR PERSONS UNDER AGE 18 WHO ARE Employment authorization document Native American tribal document (RMI) with I-94 or I-94A indicating UNABLE TO PRESENT ANY DOCUMENT ABOVE issued by the Department of Homeland non-immigrant admission Security Canadian driver’s license

BUSINESS/ORGANIZATION NAME BUSINESS/ORGANIZATION NAME

ISSUING AUTHORITY

EMPLOYER’S NAME/TITLE

EMPLOYER’S NAME, TITLE

ADDRESS ISSUING AUTHORITY

HIRE DATE

and that to the best of my knowledge the employee is authorized to work in the U.S. DATE

LIST A

{ LIST A

Form I-9 (Rev. 08/07/09) Y Page 5

OMB No. 1615-0047 Form I-9 Y Page 4

redesigning & refining

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

OMB No. 1615-0047; Expires 08/31/12

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM. THE INSTRUCTIONS MUST BE AVAILABLE DURING COMPLETION.

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS

Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.) Section 1. Employee Information & Verification EMPLOYEE NAME

(To be completed and signed by employee at the time employment begins.)

Last, First Middle (Maiden if applicable) ADDRESS

EMPLOYEE NAME (Last, First Middle, Maiden*)

EMPLOYEE SIGNATURE

Street No. & Name, Apartment No. ADDRESS (Street No. & Name, Apartment No.)

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Preparer and/or Translator Certification* Preparer and/or Translator Certification

City, State, Zip Code

(City, State, Zip Code)

SOCIAL SECURITY NO.

(To be and signed 1 if is Section 1 is prepared by a person (To be completed andcompleted signed if Section prepared other than the employee.) by a person other than the employee.)

DATE OF BIRTH

I attest, under penalty of perjury, that I have assisted

SOCIAL NO. (xxx-xx-xxxx) CHECK ONE OF THE SECURITY FOLLOWING. I attest, under

OF BIRTH (mm/dd/yyyy) penalty ofDATE perjury, that I am:

ADDRESS

EXP. DATE

DATE

ADDRESS

Street No. & Name, City, State, Zip Code PREPARER/TRANSLATOR SIGNATURE

EXP. DATE

ALIEN NO./ADMISSION NO.

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

{

}

I attest, under penalty of perjury, that I have examined

EXP. DATE

LIST B

DOCUMENT TITLE

LIST C

DOCUMENT TITLE

LIST C

B C

DOCUMENTS THAT ESTABLISH BOTH IDENTITY ANDTo EMPLOYMENT AUTHORIZATION + OR

U.S. Passport or U.S. Passport Card Permanent Resident Card or I-551 Resident Alien Card

LIST A

DOCUMENTS THAT ESTABLISH BOTH

DOCUMENT TITLE

ADDRESS (Street No. & Name)

EXP. DATE

DOCUMENT NO.

DATE

DOCUMENT NO.*

DATE*

ISSUING AUTHORITY

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENTATIVE SIGNATURE

(City, State, Zip Code)

DATE

DATE OF REHIRE (IF APPLICABLE)

(To be completed and signed by employer.) NEW NAME*

DOCUMENT NO.

DATE OF REHIRE*

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENT NO.

LIST C

Driver’s license or state-issued ID card provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address.

Social Security Account Number card excluding one which specifies that the issuance of the card does not authorize employment in the U.S.

LIST B

DOCUMENTS THAT ESTABLISH ONLY

FOR PERSONS UNDER AGE 18 WHO ARE

Day care or nursery school record School record or report card

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Day care or nursery school record

EXP. DATE

Form I-9 (Rev. 08/07/09) DOCUMENT TITLE Y Page 4

}

Clinic, doctor, or hospital record

DOCUMENT NO.

Section 3. Updating & Reverification* DOCUMENT TITLE

B+C

Clinic, doctor, or UNABLE hospitalTOrecord PRESENT ANY DOCUMENT ABOVE

Section 3. Updating & Reverification (To be completed and signed by employer.) NEW NAME (IF APPLICABLE)

School record or report card DATE

Street No. & Name, City, State, Zip Code DOCUMENT NO.

LIST B

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

*Fill out only if applicable

LIST C

DOCUMENTS THAT ESTABLISH ONLY

BUSINESS/ORGANIZATION NAME BUSINESS/ORGANIZATION NAME

ISSUING AUTHORITY

EMPLOYER’S NAME/TITLE

EMPLOYER’S NAME, TITLE

ADDRESS ISSUING AUTHORITY

HIRE DATE

and that to the best of my knowledge the employee is authorized to work in the U.S. DATE

LIST A

{ LIST A

Form I-9 (Rev. 08/07/09) Y Page 5

OMB No. 1615-0047 Form I-9 Y Page 4

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

the new form I-9

FORM I-9 EMPLOYMENT ELIGIBILITY VERIFICATION

Section 1. Employee Information & Verification (To be completed and signed by employee at the time employment begins.)

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 NAME (Last, First Middle, Maiden*)

ADDRESS (Street No. & Name, Apartment No.)

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Preparer and/or Translator Certification* (To be completed and signed if Section 1 is prepared by a person other than the employee.)

(City, State, Zip Code)

SOCIAL SECURITY NO. (xxx-xx-xxxx)

CHECK ONE OF THE FOLLOWING. I

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.

DATE OF BIRTH (mm/dd/yyyy)

attest, under penalty of perjury, that I am:

A citizen of the United States A noncitizen national of the United States (SEE INSTRUCTIONS) A lawful permanent resident of the United States ALIEN NO. An alien authorized to work until a certain date

ALIEN NO./ADMISSION NO.

PREPARER/TRANSLATOR NAME

ADDRESS

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Section 2. Employer Review & Verification (To be completed and signed by employer.)

{

B+C

}

LIST B

EXAMINE ONE DOCUMENT FROM List

A OR List B & List C as listed on the reverse of this form. Record all information for each of the appropriate document(s) without abbreviations.

HIRE DATE

ISSUING AUTHORITY

DOCUMENT NO.

LIST A

DOCUMENT TITLE

DATE

EMPLOYER’S NAME/TITLE

DOCUMENT TITLE

LIST C

BUSINESS/ORGANIZATION NAME

ISSUING AUTHORITY

DOCUMENT TITLE

ADDRESS (Street No. & Name)

ISSUING AUTHORITY

(City, State, Zip Code)

DOCUMENT NO.

DATE

DOCUMENT NO.*

DATE*

DOCUMENT NO.

DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

Section 3. Updating & Reverification* (To be completed and signed by employer.) NEW NAME*

DATE OF REHIRE*

If employee’s previous grant of work authorization has expired, provide the information below for the document that establishes current employment authorization. DOCUMENT TITLE

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENT NO.

EXP. DATE

EMPLOYER/AUTHORIZED REPRESENATIVE SIGNATURE

DATE

*Fill out only if applicable

DEPARTMENT OF HOMELAND SECURITY U.S. CITIZENSHIP AND IMMIGRATION SERVICES

the new form I-9

FORM I-9 LIST OF ACCEPTABLE DOCUMENTS ALL DOCUMENTS MUST BE UNEXPIRED. Illustrations of many of these documents appear in the M-274 Handbook for Employers Part 8.

B+C

To be eligible for employment, employee must provide either one document from List A or one document each from Lists B and C.

LIST A

LIST B

LIST C

U.S. Passport or U.S. Passport Card

Driver’s license or state-issued ID card, provided it contains a photo and/or information such as name, date of birth, gender, height, eye color and address.

Social Security Account Number card excluding one which specifies that the issuance of the card does not authorize employment in the U.S.

DOCUMENTS THAT ESTABLISH BOTH IDENTITY AND EMPLOYMENT AUTHORIZATION

Permanent Resident Card or I-551 Resident Alien Card Foreign passport containing temporary I-551 stamp or printed notation on a machine-readable immigrant visa Employment Authorization Form that contains a photograph I-766

DOCUMENTS THAT ESTABLISH ONLY IDENTITY

School record or report card Clinic, doctor, or hospital record Day care or nursery school record

OMB No. 1615-0047 Form I-9 Y Page 4

DOCUMENTS THAT ESTABLISH ONLY EMPLOYMENT AUTHORIZATION

FS-545 Certification of Birth Abroad issued by the Department of State DS-1350 Certification of Report of Birth issued by the Department of State

Original or certified copy of birth certificate bearing an official seal and issued by a state, county, municipal authority or territory of the U.S. I-197

U.S. Citizen ID Card

I-179 Identification Card for use of Resident Citizen in the United States

Native American tribal document Employment authorization document issued by the Department of Homeland Security

THANK YOU.

Sharon Silverberg srsilverberg@gmail.com 512.659.2918