Name (First, Middle, Last)
Street Address
Address (cont.)
City/Town
State/Province
Zip/Postal Code
Country
Home Phone
Alternate Phone
FAX
E-mail

Enter the date of Birth :

-- mm/dd/yy

H-2B Visa Status

Currently in Country Returning H2B First Timer

Past Experience - select any of the following:

Resort
Amusement Park
Restaurant
Retail

Describe your level of English proficiency:

Beginner Intermediate Advanced Fluent

Current Employer

Current Position.

I-94 Expiration :

-- mm/dd/yy