This form is required by federal law and MUST be completed with the proper supporting documents attached.

Detailed instructions are provided with the form and are NOT to be included in the New Hire Packet submitted to the GME Office

The House Officer completes Section #1 of the form in the format requested, and signs and dates the form

The House Officer's name must appear on page 2 where requested in the same format as page 1

Names and dates MUST be in the format requested on all pages.

Date of Hire (July 1 or other hire date), is the date entered in the Certification Section, not the date the form was completed.

Coordinator, after reviewing the documents that establish identity, completes and signs Section #2

Do not complete Section 3

Packets will be returned to the Coordinator if the I-9 is not completed correctly.