Study Form

    1 - IMMIGRATION INFORMATION
FirstName  LastName
Visa Record? Times   Explain
Please indicate if you have a visa with a U.S. Consulate General and write what was the final determination.
INS Record? Times   Explain
Please indicate if you have a record with the Immigration Service and write what was the final determination.
Indicate Type of Entry Visa   Date entered U.S.
Age at Time of Entry to U.S.  Years       Date of Birth   
    2 - RELATIVES
Do you have immediate relatives (U.S. Citizen or Legal Resident)?
If yes, indicate who
   3 - INDICATE ALIEN'S EDUCATION
Specify Degree Major Field of Study
   4 - EMPLOYMENT
Please indicate the name of your current employer

Information about the Prospective Employer/Petitioner
Company
Name of your Supervisor or Company's President
Job Title & short description
Nature of Employer's Business or Activity
* Are you paid cash or check ? 
* If by check, state the amount you are paid for the position offered  $
* Term of employment:    From to
   Number of Hours p/wk







Important: I take full responsibility of the information above stated and of all information provided to any Government Agency and I understand that until I demonstrate the experience required, my care will not be submitted to the Labor Department.