Work and Travel USA Application Form | Intrinsic

Program Application
Work and Travel USA Application Form

Fields marked with * are mandatory.

Personal Details - Please fill in all the information in English (except 中文姓名)

*Identity Card No.:

e.g. A123456(7)

Admin Fee Waiver Code:

*Last Name:

*First & Middle Name:

Preferred Name:

中文姓名:

*Gender:

Male Female

*E-mail:

*Alternative E-mail:

MSN/QQ:

Blog/Facebook:

*Date of Birth:

DD / MM / YYYY

Use this to enter.

*Place of birth :

(as shown on your passport)

*Country of Birth:

*Country of citizenship:

*Country of residence:

*Passport Type:

HKSAR BNO PRC VNM Other:

*Passport No.:

*Passport Expiry Date:

DD / MM / YYYY

Use this to enter.
valid for 6 months beyond the end of your summer holiday

Address
Room:	Floor: Block:	Building/Estate:
Street/Road:		*District:
Postal Code:		*City:
*Country:		*中文住址:

*Phone No.:

()- ()- ()
(Country code)-(Area code)-(Tel. no.) e.g. H.K. Tel. no. (852)-()-(12345678) / Guangzhou Tel. no. (86)-(20)-(23456789)

*Mobile No.:

()- ()- ()

*Are you willing to disclose your E-mail to other students who will go to the same destination and work for the same employer?

Yes No

Emergency Contact Information (Please provide your NEXT OF KIN information only)

*Last Name:

*First Name:

*Relationship:

Address
Same as above:
Room:	Floor: Block:	Building/Estate:
Street/Road:		*District:
Postal Code:		*City:
*Country:		*中文住址:

*Phone No.:

()- ()- ()

*Mobile No.:

()- ()- ()

Email:

Education
*University/Institution Name:
*Student ID number:
*Location:
*City:
*Faculty:
*Major field of study:
*Current Year of Study:
*Program Duration:
*Year of Graduation:	MM/ YYYY
*Will you be a full-time post-secondary student at the time you leave for the Program? Yes No
*Will you be a full-time post-secondary student when you return to your country of residence? Yes No

Full-Time/Part-Time Employment History

If you don't have any work experiences, please provide any school / volunteer activities that you have participated in.

	Work Experience 1(Starting from the most recent one)
*Company Name:
*Job Position:
*City:
*Country:
*Start Date:	DD / MM / YYYY Use this to enter.
*End Date:	DD / MM / YYYY Use this to enter.
*Main duties: Characters limit: (255)

	Work Experience 2
Company Name:
Job Position:
City:
Country:
Start Date:	DD / MM / YYYY Use this to enter.
End Date:	DD / MM / YYYY Use this to enter.
Main duties: Characters limit: (255)

	Work Experience 3
Company Name:
Job Position:
City:
Country:
Start Date:	DD / MM / YYYY Use this to enter.
End Date:	DD / MM / YYYY Use this to enter.
Main duties: Characters limit: (255)

How did you find out about the Program?

* Internet Leaflet Friends / Relatives School / University Other:

Nominator Information Please click here for specific terms and conditions of the Nomination Contest 2010
ID card no.:	(e.g. 234567 for A123456(7) or 011234 for PRC ID: 11010198901011234)
Last Name:
First Name:
Year of participation:

Miscellaneous Information
Hobbies:
*Computer skills:	Beginner Intermediate Advanced
*Home driving liscense?	Yes No
*International driving liscense?	Yes No
*Can you swim?	Yes No

Personal Statement

*In no more than 100 words, please describe your personality, principle interest and activities and your preference in relation to your work placement.
Please also state your reasons for applying for this exchange program.

*In no more than 150 words, please explain "Why would I make a good employee for Work and Travel job?"

For Enquiry +852 2312 0077
查询热线 +86 1322 9966 817 QQ号码 859541396 (广州) / 860113863 (北京) / 1182403983 (其它地区)

Language Proficiency
*Mandarin:	Fair Good Fluent N/A
*Cantonese:	Fair Good Fluent N/A
*English:	Fair Good Fluent N/A
*Vietnamese:	Fair Good Fluent N/A
Other:	Fair Good Fluent
Other:	Fair Good Fluent
Other:	Fair Good Fluent

Other Visa Information
*Have you ever visited US?	Yes No
*Have you ever worked in US?	Yes No
*Have you ever received a J-1 visa to enter the USA?	Yes No
*How many times?
*Program type:	(If you have more than 1 J-1 visa, please refer to the most recent one.)
*Exchange Visitor Program No.:
*Visa Sponsor:
*City:
*State:
*Start Date of Previous DS-2019:	MM / YYYY
*End Date of Previous DS-2019:	MM / YYYY *Please submit the J-1 visa copy and DS-2019 copy.
*Have you ever applied for a visa to immigrate permanently to the USA?	Yes No
*Have you ever been arrested or convicted of a crime?	Yes No
*Have you ever been refused a visa by a US Embassy / Consulate?	Yes No