Labor Certification Questionaire

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1. Alien’s Information

Full name What is your name? Full last names What is your name?

E-mail What is your email?

Phone What is your phone number?

Date of birth What is your birth date?

Country of birth Select your country of origin

Current address What is your current address?

Country Select your country

State Fill this field.

City Fill this field.

Zip code Fill this field only with numbers.

Current nationality Fill this field.

You are in United States? Select your country

What’s your status? Select one

Alien number Fill this field.

Working Permit Fill this field.

English Level Select one

2. Information about Alien’s Education

Name of high school Fill this field.

Street address What is the street address?

Country Select a country

State Fill this field.

City Fill this field.

Zip code Fill this field only with numbers.

Graduation year Select a date

Degree or certificate earned Fill this field.

2.1 If aplicable, University

Name of university Fill this field.

Street address What is the street address?

Country Select a country

State Fill this field.

City Fill this field.

Zip code Fill this field only with numbers.

Graduation year Select a date

Degree or certificate earned Fill this field.

3. Information about alien’s work experience

List all Jobs held during the past five years.

Company name Fill this field.

Type of business Fill this field.

Country Select a country

State Fill this field.

City Fill this field.

Zip code Fill this field only with numbers.

Start date Select a date

End date Select a date

Position title Fill this field.

Supervisor full name Fill this field.

Supervisor Phone Fill this field.

Supervisor position Fill this field.

Duties performed (including any specialized qualifications, certifications or licenses required) Fill this field.

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Labor Certification Questionaire

1 of 4

1. Alien’s Information

2. Information about Alien’s Education

2.1 If aplicable, University

3. Information about alien’s work experience