Email Address  (required)



Name of alien (family name, first, middle)

Address 

Type of visa 

Name of employer (full name) 

Telephone # of employer 

Address of employer 

Address where alien will work

Nature of employer's business activity

Name of job title

Total hours per week

Work schedule (from__am to__pm)

Rate of Pay  

Describe fully the job to be performed  

Education required (college degree & major field of study)  

Experience needed in job offered (years/months) 

Experience needed in related occupation


Other special requirements  

Occupational title of person who will be alien's immediate supervisor  

Number of employees alien will supervise 

Name and title of person signing form