Supplement A, Preparer and/or Translator Certification for Section 1
Supplement B, Reverification and Rehire (formerly Section 3)
Timeline
Anya Segevan
Anchorage,AK
Overview
1
1
year of professional experience
Work History
Housekeeper
Top Of The World Hotel
07.2023 - 03.2024
Maintained cleanliness and sanitation standards across assigned areas.
Assisted in inventory management of cleaning supplies and equipment.
Operated cleaning machinery to ensure efficient floor care and maintenance.
Collaborated with team members to complete daily cleaning schedules.
Education
High School Diploma -
Kiita Learning Community
Utqiagvik
Skills
Teamwork
Housekeeping
Customer service
LISTS OF ACCEPTABLE DOCUMENTS
All documents containing an expiration date must be unexpired.
Documents extended by the issuing authority are considered unexpired.
Employees may present one selection from List A or a combination of one selection from List B and one selection from List C.
Examples of many of these documents appear in the Handbook for Employers (M-274).
LIST A Documents that Establish Both Identity and Employment Authorization OR LIST B Documents that Establish Identity AND LIST C Documents that Establish Employment Authorization
3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine-readable immigrant visa
4. Employment Authorization Document that contains a photograph (Form I-766)
5. For an individual temporarily authorized to work for a specific employer because of his or her status or parole:
A. Foreign passport; and
B. Form I-94 or Form I-94A that has the following:
(1) The same name as the passport; and
(2) An endorsement of the individual's status or parole as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.
6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI
1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
3. School ID card with a photograph
4. Voter's registration card
5. U.S. Military card or draft record
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner Card
8. Native American tribal document
9. Driver's license issued by a Canadian government authority
1. Social Security Account Number card, unless the card includes one of the following restrictions:
(1) NOT VALID FOR EMPLOYMENT
(2) VALID FOR WORK ONLY WITH INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION
2. Certification of report of birth issued by the Department of State (Forms DS-1350, FS-545, FS-240)
3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal
4. Native American tribal document
5. U.S. Citizen ID Card (Form I-197)
6. Identification Card for Use of Resident Citizen in the United States (Form I-179)
7. Employment authorization document issued by the Department of Homeland Security
For examples, see Section 7 and Section 13 of the M-274 on uscis.gov/i-9-central.
The Form I-766, Employment Authorization Document, is a List A, Item Number 4. document, not a List C document.
For persons under age 18 who are unable to present a document listed above:
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record
Acceptable Receipts
May be presented in lieu of a document listed above for a temporary period.
For receipt validity dates, see the M-274.
Receipt for a replacement of a lost, stolen, or damaged List A document.
Receipt for a replacement of a lost, stolen, or damaged List B document.
Receipt for a replacement of a lost, stolen, or damaged List C document.
Form I-94 issued to a lawful permanent resident that contains an I-551 stamp and a photograph of the individual.
Form I-94 with 'RE' notation or refugee stamp issued to a refugee.
Refer to the Employment Authorization Extensions page on I-9 Central for more information.
Supplement A, Preparer and/or Translator Certification for Section 1
Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 of 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 Date (mm/dd/yyyy)
Last Name (Family Name) First Name (Given Name) Middle Initial (if any)
Address (Street Number and Name) City or Town State ZIP Code
Supplement B, Reverification and Rehire (formerly Section 3)
Instructions: This supplement replaces Section 3 on the previous version of Form I-9. Only use this page if your employee requires reverification, is rehired within three years of the date the original Form I-9 was completed, or provides proof of a legal name change. Enter the employee's name in the fields above. Use a new section for each reverification or rehire. Review the Form I-9 instructions before completing this page. Keep this page as part of the employee's Form I-9 record. Additional guidance can be found in the Handbook for Employers: Guidance for Completing Form I-9 (M-274)
Date of Rehire (if applicable) New Name (if applicable) Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Middle Initial
Reverification: If the employee requires reverification, your employee can choose to present any acceptable List A or List C documentation to show continued employment authorization. Enter the document information in the spaces below.
Document Title Document Number (if any) Expiration Date (if any) (mm/dd/yyyy)
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 the employee 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 Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy)
Additional Information (Initial and date each notation.)
Check here if you used an alternative procedure authorized by DHS to examine documents.