Form I-9 — Employment Eligibility Verification

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Section 1
Employee

Section 2
Employer

Documents
Attachments

Review
& Submit

⚠Employees must complete and sign Section 1 no later than the first day of employment.

Employee Information & Attestation

Last Name *

First Name *

Middle Initial

Other Last Names Used

Date of Birth *

Social Security Number *

Street Address *

City *

State *

ZIP *

Phone

Citizenship / Immigration Status

I attest, under penalty of perjury, that I am (check one of the following):

A citizen of the United States A noncitizen national of the United States A lawful permanent resident An alien authorized to work

Employee Signature

Signature *

Sign here with mouse or touch

Date *

Preparer / Translator (if applicable)

I did not use a preparer or translator A preparer/translator assisted me

ⓘEmployers must examine one document from List A OR one from List B plus one from List C.

Employer Review & Verification

Employee First Day of Employment *

List A — Identity & Employment Authorization

Document Title

Issuing Authority

Document Number

Expiration Date

— OR —

List B — Identity Document

Document Title

Issuing Authority

Document Number

Expiration Date

List C — Employment Authorization

Document Title

Issuing Authority

Document Number

Expiration Date (if any)

Employer Certification

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

Employer Last Name *

First Name *

Title

Organization Name *

Employer Address *

City

State

ZIP

Employer Signature *

Employer / Authorized Representative signs here

Date *

Document Attachments

List A

U.S. Passport / Passport Card
Permanent Resident Card (I-551)
Foreign Passport + I-551 stamp
Employment Auth. Doc (I-766)
Foreign Passport + I-94

List B — Identity

Driver's License
State ID Card
School ID with photo
Voter's Registration Card
U.S. Military Card

List C — Work Auth

U.S. Social Security Card
Certified Birth Certificate
DS-1350 / FS-545
Native American Tribal Doc
Employment Auth Doc (DHS)

Upload Supporting Documents *

📄

Drag & drop files here

or click to browse

Choose Files

PDF, JPG, PNG, DOC · Max 10 MB per file

🔒 Documents are transmitted securely and used only for employment eligibility verification. Originals must be presented in person.

Review & Submit

⚠Review all information carefully. Submitting false information on Form I-9 is a federal offense.

I certify that the information I have provided is truthful and accurate to the best of my knowledge. I understand that providing false information is a federal crime.

✅

Form I-9 Submitted

Your completed I-9 PDF — including signatures and document attachments — has been downloaded to your device and emailed to your employer at info@iaphcc.com. Please retain your downloaded copy for your records.

Form I-9 — Employment Eligibility Verification

Form I-9 Submitted

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