P&R Part-Time Employee I-9 Form

Part-Time Employment Eligibility Verification

USCIS Form I-9
Department of Homeland Security

U.S. Citizenship and Immigration Services
START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation

(Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer)
Name*

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

Street number and Name

Apt. Number

City or TownState

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

MonthDayYear
Date
U.S. Social Security Number*
Employee's Email Address*
example@example.com
Employee's Telephone Number*
(555) 555-5555
A citizen of the United StatesA noncitizen national of the United States (See instructions)A lawful permanent resident (Alien Registration Number/USCIS Number)An alien authorized to work until (enter the expiration date below)
Expiration date if applicable, mm/dd/yyyy
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. Alien Registration Number/USCiS Number:
2. Form I 94 Admission Number:
Foreign Passport Number:
Country of Issuance:
Signature of Employee*

Clear
Please upload a copy of your social security card, birth certificate, or other document listed under "List C" of acceptable documents on the U.S. Department of Homeland Security's I-9 Form.*

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Please upload a copy of your U.S. issued passport, U.S. issued driver's license, or a school issued photo ID.*

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Today's Date*

MonthDayYear
I did not use a preparer or translatorA preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1I 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

Clear
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Preparer Name

First Name (Given Name)Last Name (Family Name)
Preparer Address

Address (Street Number and Name)

Street Address Line 2

City or TownState

ZIP Code
Should be Empty:

Part-Time Employment Eligibility Verification

Department of Homeland Security

Section 1. Employee Information and Attestation