HC Constructors New Hire | PART IV

I-9 Employment Eligibility Verification
START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for
failing to comply with the requirements for completing this form. See below and the Instructions.
ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask
employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or
Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal.
Name*

First Name (Given Name)Last Name (Family Name)
Middle Initial
Other Last Names Used (if any)
Address*

Address (Street Number and Name)

Apt #

City or TownState

ZIP Code
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
U.S. Social Security Number*
Employee's E mail Address*
example@example.com
Employee's Telephone Number*
I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information,including my selection of the box attesting to my citizenship or immigration.
(Alien Registration Number/USCIS Number):

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident4. An alien authorized to work until
If 3 applies to you, please provide Alien Registration Number/USCIS Number:
If 4 applies to you, please provide Alien Registration Number/USCIS Number:
Some aliens may write "N/A" in the expiration date field. (See instructions)
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:

An Alien Registration Number/USCIS Number OR

Form I-94 Admission Number OR

Foreign Passport Number.
1. USCiS Number:
Or
2. Form I-94 Admission Number:
Or
Foreign Passport Number and Country of Issuance:
Signature of Employee*

Powered by Jotform SignClear
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
NEXT SECTION TO BE COMPLETED BY SUPERVISOR

Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions.
List A

Identity and Employment Authorization:
Document Title (type NA if this doesn't apply)*
Issuing Authority (type NA if this doesn't apply)*
Document Number (type NA if this doesn't apply)*
Expiration Date (if any)

MonthDayYear
Date
List B

Identity
Document Title (type NA if this doesn't apply)*
Issuing Authority (type NA if this doesn't apply)*
Document Number (type NA if this doesn't apply)*
Expiration Date (if any)

MonthDayYear
Date
List C

Employment Authorization
Document Title
Issuing Authority
Document Number
Expiration Date

MonthDayYear
Date
Additional Information if needed:
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authoruzed to work in the United States.
The employee's first day of employment:

MonthDayYear
Date
I attest, under penatly 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.
Last Name, First Name and Title of Employer or Authorized Representative :
Employer's Business or Organization Name:
Employer's Business or Organization Adress, City or Town, State, ZIP Code
Signature of Employer or Authorized Representative:*

Powered by Jotform SignClear
Today's Date:

MonthDayYear
Date
IF A TRANSLATOR WAS NOT USED, THIS SECTION DOES NOT NEED TO BE COMPLETED. Skip all below and select the continue button.
Full Name: (from Section 1)

First NameMiddle InitialLast Name
This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's completed Form I-9.
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator (1):

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Name of Preparer or Translator:

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

City or TownState

Postal / Zip Code
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator (2):

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Name

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct.
Signature of Preparer or Translator (3):

Powered by Jotform SignClear
Date:

MonthDayYear
Date
Name

First NameMiddle InitialLast Name
Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
This section is only if you require reverification, is rehired within three years or the date of the original Form I-9 was completed, or provides proof of a legal name change.
Full Name: (from Section 1)

First NameMiddle InitialLast Name
Instructions: This supplement replaces Section 3 on the previous version of Form I-9. Only use this page if your employee requiresreverification, is rehired within three years of the date the original Form I-9 was completed, or provides proof of a legal name change. Enterthe employee's name in the fields above. Use a new section for each reverification or rehire. Review the Form I-9 instructions beforecompleting this page. Keep this page as part of the employee's Form I-9 record.
Date of Rehire if applicable:

MonthDayYear
Date
New Name if applicable:

First NameMiddle InitialLast Name
Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to showcontinued employment authorization. Enter the document information in the spaces below
Document Title:
Document Name: (if any)
Expiriation Date (if any)

MonthDayYear
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 theemployee presented documentation, the documentation I examined appears to be genuine and to relate to the individual who presented it.
Name of Employer or Authorized Representative:

First NameLast Name
Signature of Employer or Authorized Representative:

Powered by Jotform SignClear
Today's Date:

MonthDayYear
Date
Additional Information:
Thank you for completing the I-9. Please have new hire press submit and continue to additional new hire forms.
Should be Empty:

I-9 Employment Eligibility Verification

NEXT SECTION TO BE COMPLETED BY SUPERVISOR