Form I-9 — Employment Eligibility Verification

Creating Lasting Memories Through Beautiful Photography.

USCIS Form I-9 collection wrapper — Section 1 (employee) at hire, Section 2 (employer) within 3 business days. Retention: 3 years after hire or 1 year after termination, whichever is later. IRCA / 8 U.S.C. § 1324a.

BTL-PBL-05.013

Form

Vol 05 — Human Resources & Talent

Section 1 — Employee Information & Attestation (completed by employee no later than first day of work)

Last name (Family) *

First name (Given) *

Middle initial

Other last names used

Address (Street, Apt., City, State, ZIP) *

Date of birth *

U.S. Social Security Number— Optional unless employer participates in E-Verify.

Employee email (optional)

Employee phone (optional)

Citizenship / Immigration status attestation *— 1) U.S. citizen · 2) Noncitizen national · 3) Lawful permanent resident (A-Number) · 4) Alien authorized to work until (date, A-Number/USCIS #, I-94, or foreign passport #).

A-Number / USCIS # / I-94 / Foreign passport # (if applicable)

I attest under penalty of perjury that I am authorized to work in the United States. *

Yes / N/A

Employee signature *

Date of signature *

Preparer / Translator Certification (if used)

Preparer/translator name & address

Preparer/translator signature

Date

Section 2 — Employer Review & Verification (within 3 business days of first day of work)

Document verification path *— One List A document OR one List B + one List C document. See USCIS Lists of Acceptable Documents.

List A — document title / issuing authority / doc # / expiration

List B — identity document title / issuer / doc # / expiration

List C — work-authorization document title / issuer / doc # / expiration

Additional info (TPS, STEM OPT, reverification, etc.)

First day of employment *

Employer / authorized representative name & title *

Employer / authorized representative signature *

Date *

Business name & address *

Supplement B — Reverification & Rehires (as needed)

New name (if changed)

Date of rehire (if applicable)

Reverification document title / doc # / expiration

Employer signature & date

Retention Note

Retention: 3 years after date of hire OR 1 year after termination, whichever is LATER (8 C.F.R. § 274a.2(b)(2)). *

Yes / N/A

Prepared by

Name · Title · Date

Reviewed by

Name · Title · Date

Approved by

Owner · Katheryn L. Wilkins · Date

Controlled document — BTL-PBL-05.013. Complete all required fields (marked *). Retain per Volume 15 retention schedule.