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Employment History

Provide the following information on all employers in the last fifteen years, if not already provided in your application.

Employer Name

Dates ofEmployment (mm-dd-yyyy)

Dates of Employment (mm-dd-yyyy)

Street Address 1

Street Address 2

City

State/Province

City

State/Province

Postal Zone/Zip Code

Country/Region

Postal Zone/Zip Code

Country/Region

Telephone Number

Job Title

Job Description

The information provided in this application and other information submitted may be provided to other U.S. government agencies having statutory or other lawful

authority to use such information, including for law enforcement and immigration law enforcement purposes. I understand that any willfully false or misleading

statement or willful concealment of a material fact made by me herein may subject me to permanent exclusion from the United States and, if I am admitted to the

United States, may subject me to criminal prosecution and/or removal.

Applicant's Signature

Date (mm-dd-yyyy)

For use by United States embassy or consulate official only:

DS-160/DS-260 Barcode Number

PAPERWORK REDUCTION ACT STATEMENT

Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time required for searching existing data

sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to

supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate

and/or recommendations for reducing it, please send them to: PRA_BurdenComments@state.gov.

CONFIDENTIALITY STATEMENT

AUTHORITIES: The information on this form is requested pursuant to Section 212(a) and 221 and as required by Section 222 of the Immigration and Nationality

Act. Section 222(f) provides that the records of the Department of State and of diplomatic and consular offices of the United States pertaining to the issuance and

refusal of visas or permits to enter the United States shall be considered confidential and shall be used only for the formulation, amendment, administration, or

enforcement of the immigration, nationality, and other laws of the United States. Certified copies of such records may, in the discretion of the Secretary of State,

be made available to a court provided the court certifies that the information contained in such records is needed in a case pending before the court.

PURPOSE: The U.S. Department of State uses the information provided on this form to determine an individual’s eligibility for a U.S. visa. Individuals who fail to

submit this form or who do not provide all the requested information may be denied a U.S. visa. Although furnishing this information is voluntary, failure to

provide this information may delay or prevent the processing of an individual visa application.

DS-5535

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