List A
List A
List A
List A
List A
List A
List A
List A
List A
List A
List A
List B
List B
List B
List C
List C
List C
Single Choice
*
1
2
3
4
Phone Number
*
Format: (000) 000-0000.
Employer's Business or Organization Address, City or Town, State, ZIP Code
Employer's Business or Organization Name
Today's Date (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date
Today's Date (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date
Last Name, First Name and Title of Employer or Authorized Representative
Check here if you used an alternative procedure authorized by DHS to examine documents.
Additional Information
Check here if you used an alternative procedure authorized by DHS to examine documents.
List C
List B
List A
Today's Date (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date
Foreign Passport Number and Country of Issuance
Form I-94 Admission Number
4. An alien authorized to work until (exp. date, if any)
/
Month
/
Day
Year
Date
USCIS- A
Employee's Email Address
*
example@example.com
U.S. Social Security Number
*
Date of Birth (mm/dd/yyyy)
*
/
Month
/
Day
Year
Date
ZIP Code
State
Please Select
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
CAN
MEX
Apt. Number (if any) City or Town
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal/Zip Code
Middle Initial (if any)Other Last Names Used (if any)
Name
*
First Name
Last Name
Last Name (Family Name)
*
Fillable I-9
Signature
*
Signature
*
Submit
Should be Empty: