Information About the Foreign National (Beneficiary)

       Family Name (Capital Letters): 

Given Name: 

Middle Name : 

Street Number & Name:

City:

State or Province:

Zip Code:

Telephone:

Fax:

Date of Birth(mm/dd/yy):

City of birth:
Country of Birth:
Date of Arrival (month/day/year):

 I-94 #::
 

Current Nonimmigrant Status:

 Expires on (month/day/year):

Foreign Address:

Do you have valid passport:

Basic information about the proposed employment and employer

Job Title:

Is this a full time position?:

Rate of Pay - Basic: 

Rate of Pay - Overtime:

Work Schedule (e.g. 9:00AM - 5:00PM):

Describe Fully the Job to be Performed (Duties):

Please State Below the Minimum EDUCATION required to perform satisfactorily the job duties described above:

Years of College Required::

Type of College Degree required::

Major Field of Study Required:
Please State Below the Minimum TRAINING required to perform satisfactorily the job duties described above
Years / Months of Training Required:
Type of Training Required:
Please State Below the Minimum EXPERIENCE required to perform satisfactorily the job duties described above
Years / Months of Experience Required in the Job Offered:
Years / Months of Experience Required in a Related Occupation:
Please Specify the Related Occupation
Other Special Requirements:
Occupational Title of the person who will be foreign national's immediate supervisor:
Number of employees foreign national will supervise
Describe efforts to recruit U.S. workers and results for the PAST SIX MONTHS:

Use this area to write any notes to us regarding this application:

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