Work & Travel USA - Travelingua

Work & Travel USAApplication Spring/Summer 2013Name of CIEE Representative:Interviewed by (name):Date (day/month/year):Country:Representative Code:Please fill in form using all capital letters.Departure and Return DatesArrival date in U.S. (DD/MM/YYYY):DS-2019 start date (DD/MM/YYYY):DS-2019 end date (DD/MM/YYYY):Date of departure from U.S. (DD/MM/YYYY):Can be no more than five days prior to DS-2019 start date.Date you want to be eligible to work in the U.S.Last day you want to be eligible to work in the U.S. Can be no more than four months after DS-2019 start date.Can be no more than 30 days after DS-2019 end date and no more than five months after arrival date.Personal Details Exactly as they appear on your passport. Please include a copy of your passport’s ID page with your application.Last Name:Middle Name:First Name:Gender: Female Male Date of Birth (DD/MM/YYYY):City of Birth:country of Birth:Country of Citizenship:country of Study:Country of Legal Residence:Passport Number:Passport Expiration Date (DD/MM/YYYY):Contact Information Permanent Home AddressHome Mailing Address:Postal Code: city: country:Phone Number (Country code - City code - Number):mobile Number:Email (Mandatory):Emergency ContactLast Name:first Name:Relationship to Participant:Address:Postal Code: city: country:Phone Number (Country code - City code - Number):mobile Number:Email:Previous Visas If you have previously received more than one J-1 Visa, please use an additional sheet of paper to provide the same information as below for each one.Have you ever received a J-1 visa to enter the USA?: Yes No If yes, how many?:If yes, please complete the following for each previous J-1 visa:Name of Program:Program Number:Name of Sponsoring Organization: city: state:Dates of Previous DS-2019 Form: From (DD/MM/YYYY): to (DD/MM/YYYY):Other Visa InformationHave you ever been denied entry into the U.S.? Yes* NoHave you ever applied for a visa to emigrate permanently to the U.S.? Yes* NoHave you ever been refused a visa by a U.S. Embassy? Yes* NoHave you ever been arrested and convicted of a crime in your home country? Yes* NoHave you ever been arrested and convicted of a crime in the U.S.? Yes* No*If you answered Yes to any of these questions, please contact your CIEE Representative.www.ciee.org/watWork & Travel USALast updated 2012.08.01

Work & Travel USAApplication Spring/Summer 2013Name of CIEE Representative:Interviewed by (name):Date (day/month/year):Country:Representative Code:University/CollegeName of Institution (e.g. university, polytechnic):City:Major Field of Study:What is the course length of your major field of study (in years)?:How many full semesters of university study have you already completed?:How many years of university study will you have completed by the time of your departure to the U.S.?:Will you be a full-time university student at the time you leave to the U.S.?:Will you be a full-time university student when you return to your country of residence?:Proof of Student Status This section must be completed by an official from your educational institution.If your educational institution will not sign this form you must attach an official letter on university letterhead verifying this same information.Option A: Student Not in Final Year of Study I certify that the named student has, as of this date, successfully completed at least one semester (or equivalent) of postsecondaryacademic study, is registered in our institution as a full-time student for the academic year 2013, and is returning tofull-time studies in the semester following the program. Additionally, I certify that in order to continue his/her studies, this studentwill be taking classroom-based courses requiring his/her physical presence in the country in which our institution is located.Option B: Student in Final Year of Study I certify that the named student has, as of this date, successfully completed at least one semester (or equivalent) of postsecondaryacademic study, is registered in our institution as a full-time student for the academic year 2013, and is expected tograduate from our institution at or before the end of this academic year.Name of Student:Name of the Official signing the Form:Signature:School Seal/Stamp:title:Date (DD/MM/YYYY):English Language Ability This section must be completed by an English teacher.Oral English Abilility 1 Beginner 2 Intermediate 3 AdvancedWritten English 1 Beginner 2 Intermediate 3 AdvancedListening Comprehension 1 Beginner 2 Intermediate 3 AdvancedAdditional comments about the student’s knowledge of English and his/her ability to function in an English-speaking workplace:Name of Teacher (Please Print):Name of Educational Institution (Please Print):Teacher’s Signature:Date (DD/MM/YYYY):How did you find out about Work & Travel USA?1 www.ciee.org 2 CIEE Representative 3 Friends/Relatives 4 School/University5 Other Website: 6 Placement Agency - Name: 7 Other:www.ciee.org/watWork & Travel USALast updated 2012.08.01

Work & Travel USAApplication Spring/Summer 2013Name of CIEE Representative:Interviewed by (name):Date (day/month/year):Country:Representative Code:Terms and Conditions / Participant DeclarationThis form includes Terms and Conditions and releases CIEE (Council on International Educational Exchange) from liability. It must be signed by all participants.I agree that the following terms and conditions are binding on me and my adherence to them is imperative.Applicant Responsibilities1. The applicant agrees that all the information provided in the application istrue to the best of his/her knowledge, and acknowledges that any false ormisleading information may lead to immediate dismissal from the Program.2. The applicant acknowledges the aims and objectives of the CIEE Work &Travel USA program as a U.S. Department of State authorized ExchangeVisitor Program, with the purpose of providing qualified students with culturalexchange opportunities in the United States.3. The applicant is responsible for considering his/her personal health andsafety needs when applying for or accepting a place on the Program. If theapplicant suffers from any health or other condition that would create a riskfor him/her while abroad, he/she should not apply.4. The applicant agrees to pay all fees in accordance with the requirements ofthe CIEE Representative through whom he/she is submitting an application.5. The Applicant is responsible for submitting all requested documentation tothe CIEE Representative in a timely fashion for visa processing. CIEE cannotbe held responsible for any additional costs incurred (including the cost ofrebooking or cancelling a flight) by the applicant due to delays in submittingdocumentation, verifying employment, or delays caused by the U.S.Embassy in processing visa applications, scheduling a visa interview, issuinga visa, or visa denial.6. Each applicant must pay the local visa fee to the U.S. Embassy. Applicantsare responsible for any additional fees that might apply at the U.S. Embassyor Consulate in the country where they are applying for the visa, as well asthe government SEVIS fee collected as part of the application.7. All applicants must attend an interview and complete language screening inorder to participate on the program.Participant Responsibilities8. The participant understands that they are expected to actively participatein American cultural activities during their program. The participant agreesto make a good faith effort to seek out and participate in American culturalactivities, and to interact with American citizens.9. The participant understands that they are expected to return home at theend of their program.10. The participant is responsible for reading and carefully considering allmaterials made available that relate to safety, health, legal, environmental,political, cultural and religious customs and conditions in the U.S. Each participantmust take full responsibility in the event that laws, regulations, orcustoms are broken, regardless of foreknowledge.11. Each participant is required to complete a CIEE Orientation.12. It is the responsibility of the participant to exercise due care once in possessionof the legal documentation (DS-2019) and visa. The cost of replacingthese items must be borne by the participant.13. The participant must supply CIEE with the name and contact details for anemergency contact, to be contacted in the case of emergency. These detailsmust be included on the application form.14. The participant is responsible for all of his or her acts along with any loss ordamage resulting therefrom while on the Program. The Participant agreesto indemnify and hold harmless CIEE and any other party that has suffereda loss by reason of the participant’s conduct.15. All travel before, during and after the Program is at the participant’s ownrisk. Any participant who chooses to operate motorized vehicles is responsiblefor obtaining the necessary license, permission and insurance anddoes so at his/her own risk.16. The participant agrees to comply rigorously with the monitoring scheduleset up by CIEE. The participant agrees to respond in a timely manner toany CIEE communication requiring a response. Failure to comply with theCIEE monitoring schedule will result in the participant’s J-1 Visa programbeing terminated, which may negatively impact the participant’s ability toobtain future U.S. visas.17. The participant must have at least $800 with him or her upon arrival in theU.S. in order to support himself or herself in the U.S. until he or she receiveshis/her first paycheck.18. If, during the course of the program the participant encounters any difficultieswith safety, health, job, housing, including charges or fees for housing,sanitary conditions, overcrowding, etc. or any other problem, the participantmust notify CIEE as soon as possible by phoning CIEE at 1-888-268-6245, 24 hours a day, 7 days a week.19. Participants on Work & Travel USA are required to comply with all U.S. Governmentvisa and immigration requirements including the SEVIS tracking asfollows: a) notification of arrival at U.S. employer to CIEE within 10 days ofDS-2019 start date; b) providing a valid address, email address, and phonenumber upon arrival at U.S. employer; c) notification to CIEE of any changein U.S. home address, phone number and/or email address within 10 daysof change. Failure to comply with these listed requirements will result inthe participant’s J-1 Visa program being terminated, which may negativelyimpact the participant’s ability to obtain future U.S. visas.Employment or Job Related Conditions20. All employment, including second jobs, must be vetted and approved byCIEE prior to work commencing. CIEE reserves the right to deny any jobaccording to the current and/or anticipated rules, regulations, and intent ofthe J-1 Exchange Visitor Program. All jobs must be seasonal in nature andnot displace year-round American workers. Employment that does not allowfor meaningful cultural exchange with Americans is not permitted. Relevantfactors include the job duties, workplace, geographical location, workschedule, and hours per week. Prohibited jobs include, but are not limitedto: au pair, childcare provider, teacher, teaching assistant, camp counselor,pedicab operator, ship or aircraft crew member, jobs involving sustainedphysical contact with other people, medical staff having patient contact,jobs involving driving a vehicle, jobs in gaming/gambling, jobs in manufacturing,jobs involving controlled hazardous substances, jobs identified ashazardous to youth by the U.S. Department of Labor. Jobs in private householdsare not permitted. Jobs in the adult entertainment industry are notpermitted, including but not limited to: escort services, adult book/videostores, massage parlors, strip clubs. Jobs with travelling concessions are notpermitted. Jobs requiring shifts that are predominantly between 10:00pmand 6:00am are not permitted. From time to time the list of prohibited jobsis updated. More information is available on the CIEE Work & Travel USAwebsite, www.ciee.org/wat.21. Under no circumstances are job positions guaranteed. Even in the casewhen an employer represents that a job is being held, this does not constitutea binding contract that the job will be available when the participantarrives. The employer’s commitment is one of good faith only.22. If the participant does not have sufficient English skills and/or does not arriveon time and/or has misrepresented any statement in the application,the job offer may be revoked.23. If the participant does not meet their contractual obligations with the employeror with CIEE, CIEE may at their sole discretion withdraw or terminatesponsorship of the participant.24. Participants must work for the employer listed on their Job Offer Form(JOF). If, for any reason, a change of employer becomes necessary, participantsmust contact CIEE and obtain written approval BEFORE changingjobs. If a participant leaves their employment without the prior writtenapproval of CIEE, or engages in employment without the prior approvalof CIEE, CIEE reserves the right to revoke his/her legal sponsorship whichwill result in the termination of his/her program and his/her legal right toremain in the U.S.25. Participants on Work & Travel USA are required to maintain communicationwith their employer prior to arrival, notify them in advance of their arrivaland departure dates, and advise them of any changes to their travel itinerarydue to visa delays or any unforeseen circumstances.26. Due to weather conditions, or other factors beyond CIEE’s control, somejobs have uncertain start dates and hours of work, and employment may becomeunavailable. CIEE/Representative are not responsible for the participant’sexpenses due to these factors, financial difficulties of the employer,or for any other reason not under the direct control of CIEE/Representative.27. Participants are solely responsible for their own conduct and well-beingboth on and off the job. CIEE cannot and does not monitor participant’spersonal conduct, subject, however, to Paragraphs 30 and 46. All participantsmust follow all United States, state, and local laws and regulations,and are subject to financial penalties, deportation and/or incarceration forbreaking laws.28. If a CIEE-sourced job position is no longer available, through no fault of theparticipant’s own, after a signed JOF has been issued to participant, or if forany reason CIEE deems it necessary to relocate a participant from a CIEEsourcedjob either before the job commences or at any time during the jobperiod, CIEE will assist the participant in finding another position but CIEEmakes no guarantee with respect to being able to do so. Nor does CIEEmake any representation that it will be able to find work for the participantin the same geographical area or of the same type of work or pay as theoriginal CIEE-sourced job.29. In case of change of job or of premature termination of job, or if the employmentis terminated before the end of the program for any reason, or if theparticipant decides to return home early, no fees will be refunded.30. If a participant is fired from his or her job for violation of employer policies,including their failure of a company-required drug test at the commencementof or anytime during employment, he or she will be withdrawn fromthe program with no refund of program or CIEE Job Service fees.31. If the participant’s original job ends before the legal working dates listedon the DS-2019 for any reason, it is the participant’s responsibility to informCIEE and get approval for any new job.Contractual Terms32. This English language version of the Contract is the binding contract betweenthe participant and CIEE.33. CIEE makes no presentation or warranty of any kind, expressed or implied,as to the suitability of the Program for any participant and CIEE disclaims allsuch warranties to the full extent of the law.34. The conduct of the Work &Travel USA Program is subject to U.S. governmentapproval and may change without notice.35. The participant understands that perceived or actual epidemics (such as,but not limited to, SARS or bird flu) can seriously delay, disrupt, interruptor cause the cancellation of entire programs. The participant agrees toassume all risks and losses (including financial) which result from any suchoccurrence.36. CIEE does not own or operate any entity which is to or does provide goodsor services for the program including, for example, arrangements for orownership or control over houses, apartments or other lodging facilities,airline, vessel, bus or other transportation companies, food service or entertainmentproviders, etc. All such persons and entities are independentcontractors. As a result, CIEE is not liable for any negligent or willful actor failure to act of any such person or entity, or of any third party. Withoutlimitation, CIEE is not responsible for any injury, loss, or damage to personor property, death, delay or inconvenience in connection with the provisionof any goods or services occasioned by or resulting from, but not limitedto, acts of God, force majeure, acts of war or civil unrest, insurrection orrevolt, strikes or other labor activities, criminal or terrorist activities or thethreat thereof of any kind, overbooking or downgrading of accommodations,structural or other defective conditions in houses, apartments orother lodging facilities (or in any heating, plumbing, electrical or structuralproblem therein), mechanical or other failure of airplanes or other means oftransportation or for any failure of any transportation mechanism to arriveor depart in a timely manner, dangers associated with domestic or wild animals,sanitation problems, food poisoning, disease, epidemics or the threatthereof, lack of, access to or quality of medical care, difficulty in evacuationin case of medical or other emergency, or for any other cause beyond thedirect control of CIEE.37. The participant agrees that any dispute concerning, relating, or referringto the JOF, to the Work & Travel USA Application, to any other literatureconcerning the program, or the program itself shall be resolved exclusivelyby binding arbitration in Portland, Maine, according to then existing commercialrules of the American Arbitration Association. Such proceedings willbe governed by substantive Maine law. The arbitrator and not any federal,state, or local court or agency shall have exclusive authority to resolve anydispute relating to the interpretation, applicability, enforceability, conscionability,or formation of this contract, including but not limited to any claimthat all or any part of this contract is void or voidable.38. CIEE reserves the right to provide participants with information CIEE deemsuseful to program participants, including but not limited to tax, travel andrelated services.CIEE Program-Related Conditions39. CIEE reserves the right to refuse sponsorship of any applicant that CIEEdeems does not meet the Program eligibility requirements or any applicantthat CIEE does not deem appropriate to accept in the general interests ofthe Program. In the event that CIEE refuses an applicant acceptance onthe Program, any refund will be made via the CIEE Representative throughwhom the original application was submitted.40. Participation on the Program begins when the participant legally enters theU.S. and terminates on the day of departure from the U.S. (within the legalProgram dates). Participation on the Program will end a maximum of fivemonths from arrival in the U.S. Participants can arrive five days prior to theirDS-2019 start date and remain in the U.S. up to 30 days beyond their DS-2019 end dates, as long as their total stay in the U.S. does not exceed fivemonths. Participants must return to their home country in time for the startof their university classes.41. CIEE may issue a DS-2019 form if a participant meets the Work & TravelUSA Program requirements, but cannot guarantee that the U.S. Embassy orConsulate in a participant’s country of residence will issue a J-1 visa.42. Once a participant has commenced his/her travel to the U.S. CIEE cannotamend the program dates as listed on the DS-2019 for any reason. It is theparticipant’s responsibility to check prior to travel that the dates are correct.43. Individuals who have recently held a J-1 visa for the U.S. may have to remainin their home country for a minimum of 90 days before CIEE can issue a DS-2019 for Work & Travel USA. Please contact your local CIEE Representativeand local U.S. Embassy for details.44. Insurance is provided for the dates confirmed by CIEE, by the CIEE insuranceprovider, as a mandatory part of the CIEE program for each applicant.It is the responsibility of each participant to purchase further insuranceshould they extend their period abroad for any reason. CIEE cannot be heldresponsible for any insurance claim in the event that a participant has failedto secure adequate insurance.45. Under the U.S. government’s Health Insurance Portability and AccountabilityAct (HIPAA), CIEE is restricted in its access to certain medical informationor records in the event that a participant has an accident in the U.S.In order for CIEE to assist participants to the fullest extent possible withany insurance-related issues, CIEE will need to have a signed Privacy andConfidentiality Release Form from the participant. This form is optional andthe participant can choose whether or not CIEE is granted access to thisinformation. This release form and additional information about the HIPAArequirements are included as part of the Work & Travel USA applicationpack. If you did not receive this information or release form please contactyour CIEE Representative.46. CIEE reserves the right to dismiss from the Program any participant whois deemed by CIEE to be a danger to himself/herself or others or whoseconduct is deemed to be detrimental to the Program. In the event of sucha dismissal, CIEE shall not be held responsible for any airfare, charges orany other expense incurred by the participant, and shall not be required toreturn any fees paid by the participant.47. CIEE reserves the right to utilize publicly available information, includingsocial media, that has not been directly provided to us by the participant.Information obtained through these means can be used as a basis for withdrawal,denial of a job offer, and/or any decisions made by CIEE affectingthe participant’s program.48. Once the participant has departed for the U.S., there will be no refundshould the participant leave the Program. There will also be no refundshould CIEE withdraw sponsorship.49. CIEE/Representative do not provide housing. If the participant’s employerprovides housing, it may be on a first-come, first-served basis. The participantmust notify CIEE if they have any concerns regarding the safety and/or suitability of the housing provided by their employer. If the participantarranges housing independently, they agree to use their best judgment insecuring housing that is safe and suitable. Housing arrangements that involveovercrowding and/or hot-bunking (multiple individuals using one bedand sleeping in shifts) are strictly prohibited. If the participant has any doubtabout the suitability of their housing, they must notify CIEE immediately.50. CIEE may provide the participant’s contact information to third parties whoprovide useful services to exchange program participants. Third parties receivingthis information will be required to provide the participant with theopportunity to opt out after the first contact.51. The Participant gives CIEE permission to use any written, photographic, orvideo images of himself/herself in the course of reporting on and/or promotingCIEE programs.I confirm that the statements contained in this application form are accurate to the best of my knowledge, and I understand and accept the Standard Terms and Conditions.Participant’s Name:Participant’s Signature:Date (DD/MM/YYYY):For further reference please make a copy of the above Terms & Conditions.www.ciee.org/watWork & Travel USALast updated 2012.08.01

Work & Travel USAApplication Spring/Summer 2013Name of CIEE Representative:Interviewed by (name):Date (day/month/year):Country:Representative Code:Interview Form This form should be filled out by a CIEE Representative based on in-person interview.Applicant DetailsLast Name:First Name:middle Name:Interview Details To be filled out by a CIEE Representative based on in-person interview.Have you ever been to the U.S. before? Yes NoIf yes, for what purpose?:What are the benefits to you of spending a summer living and working in the U.S.?:Do you already have a job in the U.S.? Yes NoIf no, what type of work do you hope to find?:Do you have friends or relatives currently living in the U.S.? Yes NoDo you plan to travel in the U.S. during your stay? Yes NoReturn from the U.S.What do you plan to do upon your return from the U.S.? Other (please specify): Continue studyingWould you consider doing an internship in the U.S. in the future? Yes NoInterviewed byFull name:title:Signature:Additional Notes / Comments:Date (DD/MM/YYYY):www.ciee.org/watWork & Travel USALast updated 2012.08.01

Work & Travel USA - Travelingua

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