Opt Proof Of Employment Form printable pdf download

Opt Proof Of Employment Form

OPT Proof of Employment

* The information on this document is collected for the below mentioned individual’s reporting purpose to

the U.S. Department of Homeland Security during his/her Optional Practical Training period.

To be completed by the Student

Name: _________________________________________________________ COC ID#: __________________

Associate Degree/Certificate Course: __________________________________________________________

To be completed by student’s Employer

This is the evidence of employment for ___________________________________________________________

Student’s Name

Job Title: __________________________________________________________________________________

Nature of student’s job: _____________________________________________________________________

__________________________________________________________________________________________

Start Date: _________________ End Date: ________________ Hours/Week:

more than 20 hours/week

Month / Date / Year

20 or less hours/week

Employer Information:

Employer Name: ____________________________________________ Employer EIN: ________-__________

Address: _______________________________________________________________________Zip:________

Supervisor Information:

Last Name: ___________________________________ First Name: __________________________________

Phone Number: ______________________ Email Address: ________________________________________

Employer Signature: __________________________________________ Date: ____________________

International Students Program 26455 Rockwell Canyons Road, Santa Clarita, CA 91355

Opt Proof Of Employment Form