Eb-2/eb-3 Information Form (Eta Form 9089) Page 2
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1
2B. Work history
After you receive the
employment certification letters
from your prior employers, list each relevant job in reverse
chronological order from the last three years. If there are any positions from more than three years ago in which you gained
MQs/DQs for the UH position, also obtain employment letters for those jobs and list them. Attach extra sheets if necessary.
Job 1 (current position)
Employer:____________________________________________________ Employer’s phone #:_______________________
Address:_____________________________________________________________________________________________
__________________________ ___________________________ ____________________________ __________________
city
state/province
country
postal code
Type of business:__________________________________ Job title:_____________________________________________
Start date:_______________ End date:_______________ # of hours/week:_____ Supervisor:_________________________
mm/dd/yyyy
mm/dd/yyyy
Job 2
Employer:____________________________________________________ Employer’s phone #:_______________________
Address:_____________________________________________________________________________________________
__________________________ ___________________________ ____________________________ __________________
city
state/province
country
postal code
Type of business:__________________________________ Job title:_____________________________________________
Start date:_______________ End date:_______________ # of hours/week:_____ Supervisor:_________________________
mm/dd/yyyy
mm/dd/yyyy
Job 3
Employer:____________________________________________________ Employer’s phone #:_______________________
Address:_____________________________________________________________________________________________
__________________________ ___________________________ ____________________________ __________________
city
state/province
country
postal code
Type of business:__________________________________ Job title:_____________________________________________
Start date:_______________ End date:_______________ # of hours/week:_____ Supervisor:_________________________
mm/dd/yyyy
mm/dd/yyyy
Job 4
Employer:____________________________________________________ Employer’s phone #:_______________________
Address:_____________________________________________________________________________________________
__________________________ ___________________________ ____________________________ __________________
city
state/province
country
postal code
Type of business:__________________________________ Job title:_____________________________________________
Start date:_______________ End date:_______________ # of hours/week:_____ Supervisor:_________________________
mm/dd/yyyy
mm/dd/yyyy
I have provided accurate information about my immigration status, education, and work history on this form.
Beneficiary’s signature:_________________________________________________ Date:___________________________
UH FSIS | | rev. Apr 2016
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