Authorized Representative
Form I-9 Employment Verification
Service Record
Notary Service Documentation
USCIS Form I-9 · Section 2
Notice: This is the notary's internal service record only. It does not replace the official USCIS Form I-9, which must be completed separately by the employer. The notary acts as authorized representative on behalf of the employer to physically examine documents and complete Section 2 of the employer's I-9 form.
1
Service Information
2
Employee Information
3
Documents Physically Examined
List A — Identity and Employment Authorization
One document establishes both identity and work authorization
or
List B — Identity
Must be used with List C
List C — Employment Authorization
Must be used with List B
4
Authorized Representative Certification
I attest, under penalty of perjury, that I have physically examined the documents presented by the employee named above, that to the best of my knowledge the documents appear to be genuine and relate to the employee named, and that the employee began employment on the date stated. I completed Section 2 of the employer's USCIS Form I-9 as authorized representative on behalf of the employer named above.
Authorized Representative Signature
Signature of Authorized Representative
Date
Date Signed
