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Supplement A, <br />Preparer and/or Translator Certification for Section 1 <br /> <br /> <br /> <br /> <br />Department of Homeland Security <br />U.S. Citizenship and Immigration Services <br />USCIS <br />Form I-9 <br />Supplement A <br />OMB No. 1615-0047 <br />Expires 07/31/2026 <br />Last Name (Family Name) from Section 1. First Name (Given Name) from Section 1. Middle initial (if any) from Section 1. <br />Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 <br />of Form I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translator <br />must complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee's <br />completed Form I-9. <br />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 <br />knowledge the information is true and correct. <br />Signature of Preparer or Translator Date (mm/dd/yyyy) <br />Last Name (Family Name) First Name (Given Name) Middle Initial (if any) <br />Address (Street Number and Name) City or Town State ZIP Code <br />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 <br />knowledge the information is true and correct. <br />Signature of Preparer or Translator Date (mm/dd/yyyy) <br />Last Name (Family Name) First Name (Given Name) Middle Initial (if any) <br />Address (Street Number and Name) City or Town State ZIP Code <br />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 <br />knowledge the information is true and correct. <br />Signature of Preparer or Translator Date (mm/dd/yyyy) <br />Last Name (Family Name) First Name (Given Name) Middle Initial (if any) <br />Address (Street Number and Name) City or Town State ZIP Code <br />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 <br />knowledge the information is true and correct. <br />Signature of Preparer or Translator Date (mm/dd/yyyy) <br />Last Name (Family Name) First Name (Given Name) Middle Initial (if any) <br />Address (Street Number and Name) City or Town State ZIP Code <br />Form I-9 Edition 08/01/23 Page 3 of 4 <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: 177AA06A-30B4-42FF-A85A-78B5A7C51DBE