America Work Visa, Inc

H2B Applicants Application Form

If the worker does not have an email, please enter the recruiter's email or email of the person who completed this form.

This form is completed by:
Recruiter/Company Name *		(Please use exactly the same information here if you are filling out more than one application)
Country *
Referred by

Job Position *
Worker Status			If substitute, original worker's name
Current US Visa, If available			Passport, If available
Visa Expiration Date		(MM/DD/YYYY)
Passport Expiration Date		(MM/DD/YYYY)

Personal Information
Name(as shown on passport)	Last Name * Middle Name(if you have) First Name *
	Social Security No, if available
	Date Of Birth *	(MM/DD/YYYY)	Gender *
	Marital Status *		E-mail *
	Cell Phone		Home Phone *
Current Address	Street *		City *
	State/Province		Zip Code
	Country *
Permanent Address(if different from current)	Street		City
	State/Province		Zip Code
	Country
In case of emergency	Contact Name		Phone

Education
	Highest Level of Education		Major (if graduated from College)
	Graduation Year

Work Experience (From the Latest)
	Company Name		Job Title
	From	(MM/YYYY)	To	(Present or MM/YYYY)
	Job Description

	Company Name		Job Title
	From	(MM/YYYY)	To	(MM/YYYY)
	Job Description


	English Level *		Physical Ability

Have you ever applied for US Visa? If yes, what type of Visa?