Bright Sky Group of Services

I-9 eSignature


Form I-9
Employment Eligibility Verification

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.)

Last Name (Family Name):   First Name (Given Name):   Middle Initial:  

Other Last Names Used (if any):  

Address:  

Date of Birth: 01-01-1970  U.S. Social Security Number:  

Employee's E-mail Address:   Employee's Telephone Number:  

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.

I attest, under penalty of perjury, that I am:

  1. Alien Registration Number/USCIS Number:
  2. Form I-94 Admission Number:  
  3. Foreign Passport Number:   Country of Issuance:
  • I am an alien authorized to work until: 01-01-1970
  • Some aliens may write "N/A" to the right instead of an expiration date:  

SECTION 2. EMPLOYER OR AUTHORIZED REPRESENTATIVE REVIEW AND VERIFICATION

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

EMPLOYEE INFO FROM SECTION 1

Last Name (Family Name):   First Name (Given Name):   Middle Initial: 

Citizenship/Immigration Status:

LIST A
Identity and Employment Authorization

Document Title:  

Issuing Authority:

Document Number:  

Expiration Date (if any): 01-01-1970 

Document Upload:


LIST B
Identity

Document Title:  

Issuing Authority:  

Document Number:  

Expiration Date (if any): 01-01-1970 

Document Upload:  


LIST C
Employment Authorization

Document Title:  

Issuing Authority:

Document Number:  

Expiration Date (if any): 01-01-1970 

Document Upload:  

 

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 authorized to work in the United States.

The employee's first day of employment:  

Last Name of Employer or Authorized Representative:   First Name of Employer or Authorized Representative:

Title of Employer or Authorized Representative:

Employer's Business or Organization Name:  

Employer's Business or Organization Address:
 

 

Leave this empty:

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Signature Certificate
Document name: I-9 eSignature
lock iconUnique Document ID: 73721699f8201444cd583b5b36df38a6d440c8c9
Timestamp Audit
January 14, 2021 10:37 pm CSTI-9 eSignature Uploaded by Megan Ford - megan@meganforddesign.com IP 98.213.216.126