H-2B Visa USA Employee Information and Application Request

If you are already in the U.S.:

If you are already in the U.S. on an H-2B Visa, please complete our H-2B Visa Extension Form.

If you are not yet in the U.S.:

If you are not yet in the U.S. and you are interested in applying for the H2B Work USA program, please fill out the boxes below and we will contact you with more details. Fields marked with an asterisk (*) are required.

First Name: *
Last Name: *
Email: *
Home Phone:
Mobile Phone:
Street Address Line 1:
Street Address Line 2:
City:
State, Province:
Postal Code:
Country: *	--Select One--AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of the CongoRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenYugoslaviaZambiaZimbabwe
Date of Birth: *	Month -----JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day ---01020304050607080910111213141516171819202122232425262728293031 Year ---19601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871989
InterExchange H-2B Visa USA can offer visa assistance, job placement assistance or both. Please select the one that applies to you. *	-Select One-Visa assistance onlyJob placement and visa assistance
If you are interested in job placement assistance, what season are you planning to work? Note: Most placements last 6 or 7 months. *	-Select One-Summer (Start between April & June)Winter (Start between October & December)No preference
What type of work interests you? Select all that apply.	Kitchen Staff  Dishwasher  Dining Room Attendant  Food and Beverage Sales  Waitstaff/ Hoststaff  Sales Help  Cashier  Housekeeping  Ski Lift Operator  Ski Instructor  Concierge  Front Desk  Lifeguard  Ride Operator  Other
If other, please describe:
Have you worked in the U.S. on an H-2B visa within the last 3 years?	Yes  No
Company Name:
City:
State:	--Select One--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
How did you hear about us? *	---Another WebsiteBook/MagazineCraigslistEmbassy/State Dept.Friend/Family/Past ParticipantGoogle/Yahoo SearchLocal Partner OfficePoster/BrochurePre-match with Host FamilyProfessor/Advisor/Campus EventReferred by U.S. Employer / CampTravel AgencyOther
Please explain. Name of book, online search words, website, where you saw a poster, name of professor/advisor, etc.