Summer Work Travel Program Application 2016

Passport Details (copy exactly as in passport)

Family Name

First Name Middle Name

Date of Birth (Month/Day/Year) Age PLACE

Male Female PHOTO
City of birth Country of Birth
HERE
Country of citizenship Country of legal permanent residence

Passport Number Date of issue Date of Expiration

Contact details
Permanent Address (Parental home)

City Region Postcode Country

Home phone Mobile Phone Email

University Information

Name of University Field of Study

Length of course How many years have you completed? Are you enrolled full-time? Yes No
Previous Visa Information

Have you had a previous Summer Work Travel J-1 visa? Yes No If yes, how many?

Please list the years of your previous J-1 visa and who your sponsor was (Year / Sponsor).

Have you ever been refused a visa? No Yes. Please explain.

Have you ever been arrested or convicted of a crime? No Yes. Please explain.

Employment

Estimated Job Start Date: Estimated Job End Date:

Have you worked before? Yes No If yes, please complete below. Have you had a J-1 visa before? Yes No
Job 1 Company Dates of employment

City, State, Country Supervisors name Supervisors phone number

Give job title and describe duties and responsibilities

Job 2 - Company Dates of employment

City, State, Country Supervisors name Supervisors phone number

Give job title and describe duties and responsibilities

Please list the languages you speak and your level of fluency
(beginner, early intermediate, intermediate, upper intermediate, fluent).

Driving: I do not have a driving license. I have an International drivers license I have a home country drivers license.
Office use only: Friends Group
Name:

Emergency Contact

Name of emergency contact Relationship to you

Address of Emergency contact

Telephone Mobile Email

Personal Information Please answer in full. The information here will be used to assess your English language skills and to determine your job placement
(if applicable)
Why do you want to work in the USA?

What personal qualities and skills can you offer an employer?

What are your interests and hobbies?

What makes you different from other people?

If you have worked before, what did you enjoy about the job?

Are there any jobs that you would or would not like to have and why?

Living and working in the USA is not always easy. What do you think will be the hardest part? How will you deal with this?

If things dont go the way you expected, how will you handle this? What is your plan B?

Give an example of a difficult situation that you have dealt with in the past.

What travel have you have done in your home country or abroad?

How have you prepared for your trip to the USA?

Do you agree to take at least $US800 with you to the USA to cover expenses for the first 4-6 weeks ($1,200 recommended)? Yes No
I declare that all the statements and information provided on this application are true. I understand that any false declaration may result in losing my place on the SWT
program with no entitlement to a refund or of consequent expenses.

Signature
Date

Updated 09/15