Reader Registered

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

Address (Street Number and Name) ZIP Code

Last Name (Family Name) First Name (Given Name)

Signature of Preparer or Translator Date (mm/dd/yyyy) 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.

City or Town

Instructions: This supplement may be used if extra spaces are required to document more than one preparer and/or translator assisting 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. 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. State

Address (Street Number and Name) ZIP Code

Last Name (Family Name) First Name (Given Name)

Signature of Preparer or Translator Date (mm/dd/yyyy) 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.

City or Town State

Address (Street Number and Name) ZIP Code

Last Name (Family Name) First Name (Given Name)

Signature of Preparer or Translator Date (mm/dd/yyyy) 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.

City or Town State

Address (Street Number and Name) ZIP Code

Last Name (Family Name) First Name (Given Name)

Signature of Preparer or Translator Date (mm/dd/yyyy) 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.

City or Town State

USCIS

Form I-9

Supplement

OMB No. 1615-0047

Expires 10/31/2022

Form I-9 Supplement,

Section 1 Preparer and/or Translator Certification Department of Homeland Security

U.S. Citizenship and Immigration Services

Form I-9 Supplement 10/21/2019 Page 1 of 1

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