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U.S. DEPARTMENT OF HOMELAND SECURITY |
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Supplement B, |
Reverification and Rehire (formerly Section 3) |
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Department of Homeland Security |
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U.S. Citizenship and Immigration Services |
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USCIS |
Form I-9 |
Supplement B |
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OMB No. 1615-0047 |
Expires 07/31/2026 |
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Last Name (Family Name) from Section 1. ___ |
First Name (Given Name) from Section 1. ___ |
Middle initial (if any) from Section 1. ___ |
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... |
Date of Rehire (if applicable) |
Date (mm/dd/yyyy) ___ |
New Name (if applicable) |
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. |
Date of Rehire (if applicable) |
Date (mm/dd/yyyy) ___ |
New Name (if applicable) |
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. |
Date of Rehire (if applicable) |
Date (mm/dd/yyyy) ___ |
New Name (if applicable) |
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. |
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Form I-9 Edition 08/01/23 |
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Page 4 of 4 |
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