Email: info@j1ireland.com | Tel: 090 6494997

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J-1 Summer
J-1 Camp
J-1 Grad Visa
J-1 Intern
J-1 Trainee
J-1 Career Placement

J-1 Intern Program Application Form

Step 1 of 7

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Please Have Required Documents Ready for Upload in Order to Complete Form

Your program start date must be within 12 months of your final class at your University.
1. Signed & Stamped Copy Of Proof Of College (Download link) PDF or Scan Of Graduation Certificate or College Proof of Attendance. Just one of these has to be uploaded.
2. Signed Copy Of Rules & Regulation Form PDF (Download link)
3. T/IPP Questionnaire (Download link) Notes on Training Plan must be adhered to.
4. Business or organisation's Worker's Compensation Document
5. CV or Resume PDF
6. Passport JPEG. Good quality scan - not a photo.
7. Financial Security Statement.Download, print and sign.
8. Copy of previous US visas if applicable PDF.
9. Copy of Irish visa (third party nationals) if applicable PDF.

J-1 INTERN PROGRAM FOR IRELAND 2017 PROGRAM APPLICATION

PERSONAL INFORMATION

Important! This information must appear exactly as it does on your passport.
Full Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Place of Birth*
Nationality*
Citizen of*
Permanent Resident of*
If you have graduated, are you currently working?
PERMANENT ADDRESS
Address*
Town/City*
County/PostCode*
Country*
Phone*
Mobile*
Email*
Enter Email Confirm Email
EMERGENCY CONTACT
Name*
First Last
Relationship*
Address*
Town/City*
County/PostCode*
Country*
Phone*
Mobile*
Email*
Enter Email Confirm Email

COLLEGE ATTENDANCE DETAILS
COLLEGE ATTENDANCE DETAILS
College*
College Address*
Degree/Diploma/Certificate Course*
(Eg. Bachelor of Business Studies BSc Business, Masters of Elkectrical Engineering MSc Engineering)
Graduation Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Personal Reference
Name*
First Last
Relationship*
Address*
Email*
Contact Number*
Professional Reference
Name
First Last
Relationship*
Name of Company or Organisation*
Address*
Email*
Contact Number*

VISA AND TRAVEL INFORMATION
Have you ever received a J-1 visa to enter the US?*
If yes, please fill out the following for each visa:
How many times?*
Please enter a number from 1 to 2.
Name of Program*
Number*
Sponsoring Organisation*
Dates of Previous DS-2019: Start Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
End Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Name of Program*
Number*
Sponsoring Organisation*
Dates of Previous DS-2019: Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Have you ever received a J-1 Intern visa to enter the US?*
If yes, please fill out the following for each visa:
Name of Program*
Number*
Sponsoring Organisation*
Dates of Previous DS-2019: Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Have you ever applied for a visa to immigrate permanently to the US?*
Select Yes or No
Have you ever been arrested or convicted of a crime?*
Select Yes or No
Have you ever been refused a visa by the US Embassy?*
Select Yes or No
Do you have any health issues that might be a barrier to success?*
Select Yes or No
INTENDED START/COMPLETION DATES
Intended Flight to US Travel Date
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy.
Preferred start date of program (actual on-program dates)
MM slash DD slash YYYY

Note: you can enter up to 30days prior to the date above. American Date Format: mm/dd/yyyy.
Preferred end date of program (actual end-of-program date)
MM slash DD slash YYYY

Note: your program allows a 12 month opportunity and you can depart up to 30 days after the date above. American Date Format: mm/dd/yyyy.

EXPECTATIONS
How did you first learn of the J-1 Intern Program?*
What attracted you to the J-1 Intern Program and what do you expect to gain?*
What about the J-1 Intern Program do you believe will prove most beneficial upon return to your home country?*
INTERNSHIP INTERESTS
Describe your ideal internship?*
Have you begun to look for an internship?*

HISTORIC, SOCIETAL, CULTURAL INFORMATION
The United States Department of State believes that a participant coming to the United States on a J1 Program – should not only gain a valid internship to help with their future career – but should also gain a better understanding of America and it’s History, Society & Culture. We agree!! Tell us a little bit about what might interest you while you are here and we will develop a program of learning for you. (check all that apply).
HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATION
check all that apply
History
- The American Revolution
- 19th Century Industrialization
- 20th Century
Society
- The Political System
- Local Politics
- Volunteering Opportunities
Culture
- African American Culture
- Native American Culture
- Other Cultures
Sports
- American Football
- Baseball
- Basketball
- Bowling
- Cycling
- Horse Racing
- Soccer
- Softball
- Swimming
- Track & Field
The Arts
- Art Galleries
- Movies
- Music**
- Theater
- Literature
*
**What genre of Music?

APPLICATION CHECKLIST
1. SIGNED & STAMPED COPY OF PROOF OF COLLEGE PDF
2. SIGNED COPY OF RULES & REGULATION FORM PDF
3. CV or RESUME PDF
4. REFERENCES PDF
5. PASSPORT JPEG
6. PROOF OF FUNDS PDF
7. COPY OF PREVIOUS US VISAS IF APPLICABLE PDF
8. COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE PDF
T/IPP QUESTIONNAIRE, PROOF OF COLLEGE PDF, PROOF OF LAST DAY OF CLASSES, RULES & REGULATION,CV or RESUME, WORKER'S COMPENSATION DOCUMENT, PROOF OF FUNDS, COPY OF PREVIOUS US VISAS IF APPLICABLE, COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE*
Drop files here or

Accepted file types: pdf, docx, jpeg, Max. file size: 2 MB, Max. files: 7.
Upload Required PDF Documents. Allow time for documents to upload (Max file sizes: 2MB).
PASSPORT JPEG*
Drop files here or

Accepted file types: jpg, Max. file size: 2 MB, Max. files: 2.
Upload Required JPG. Allow time for documents to upload (Max file size: 2MB).
Check*
- Proof of College (pdf, correct orientation)
Check*
- Proof of Last Day of Classes (pdf, correct orientation)
Check*
- Rules & regulations signed (pdf – 1-doc, 2-pages, correct orientation)
Check*
- Worker's Compensation Document
Check*
- CV or Resume (pdf, correct orientation)
Check*
- Photocopy of Personal Details in your Passport (JPEG – professionally scanned, correct orientation)
Check*
- Proof of Funds (> $1500) (pdf, correct orientation)
Check if applicable
- Copy of Previous US Visas (if applicable) (pdf, correct orientation)
Check if applicable
- Copy of Irish Visa (Third Country Nationals) (pdf, correct orientation)
Email
This field is for validation purposes and should be left unchanged.

Contact Info

Phone: +353 (0)90 6494997
Email: info@j1ireland.com
Mon-Fri: 9.30 AM t0 5:00PM

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Step 1 of 7

Please Have Required Documents Ready for Upload in Order to Complete Form

J-1 INTERN PROGRAM FOR IRELAND 2017 PROGRAM APPLICATION

PERSONAL INFORMATION

PERMANENT ADDRESS

EMERGENCY CONTACT

COLLEGE ATTENDANCE DETAILS

COLLEGE ATTENDANCE DETAILS

Personal Reference

Professional Reference

VISA AND TRAVEL INFORMATION

INTENDED START/COMPLETION DATES

EXPECTATIONS

INTERNSHIP INTERESTS

HISTORIC, SOCIETAL, CULTURAL INFORMATION

HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATION

APPLICATION CHECKLIST

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J-1 Intern

J-1 Trainee

J-1 Career Placement